Management of the Kidney Transplant Patient with Chronic Hepatitis C Infection

Chronic Hepatitis C (HCV) infection is an important cause of morbidity and mortality in patients with end-stage renal disease. Renal transplantation confers a survival advantage in HCV-infected patients. Renal transplant candidates with serologic evidence of HCV infection should undergo a liver biopsy to assess for fibrosis and cirrhosis. Patients with Metavir fibrosis score ≤3 and compensated cirrhosis should be evaluated for interferon-based therapy. Achievement of sustained virological response (SVR) may reduce the risks for both posttransplantation hepatic and extrahepatic complications such as de novo or recurrent glomerulonephritis associated with HCV. Patients who cannot achieve SVR and have no live kidney donor may be considered for HCV-positive kidneys. Interferon should be avoided after kidney transplant except for treatment of life-threatening liver injury, such as fibrosing cholestatic hepatitis. Early detection, prevention, and treatment of complications due to chronic HCV infection may improve the outcomes of kidney transplant recipients with chronic HCV infection

Management of the Kidney Transplant Patient with Chronic Hepatitis C Infection

Chronic Hepatitis C (HCV) infection is an important cause of morbidity and mortality in patients with end-stage renal disease. Renal transplantation confers a survival advantage in HCV-infected patients. Renal transplant candidates with serologic evidence of HCV infection should undergo a liver biopsy to assess for fibrosis and cirrhosis. Patients with Metavir fibrosis score ≤3 and compensated cirrhosis should be evaluated for interferon-based therapy. Achievement of sustained virological response (SVR) may reduce the risks for both posttransplantation hepatic and extrahepatic complications such as de novo or recurrent glomerulonephritis associated with HCV. Patients who cannot achieve SVR and have no live kidney donor may be considered for HCV-positive kidneys. Interferon should be avoided after kidney transplant except for treatment of life-threatening liver injury, such as fibrosing cholestatic hepatitis. Early detection, prevention, and treatment of complications due to chronic HCV infection may improve the outcomes of kidney transplant recipients with chronic HCV infection

Background Light in Potential Sites for the ANTARES Undersea Neutrino Telescope

The ANTARES collaboration has performed a series of {\em in situ} measurements to study the background light for a planned undersea neutrino telescope. Such background can be caused by $^{40}$K decays or by biological activity. We report on measurements at two sites in the Mediterranean Sea at depths of 2400~m and 2700~m, respectively. Three photomultiplier tubes were used to measure single counting rates and coincidence rates for pairs of tubes at various distances. The background rate is seen to consist of three components: a constant rate due to $^{40}$K decays, a continuum rate that varies on a time scale of several hours simultaneously over distances up to at least 40~m, and random bursts a few seconds long that are only correlated in time over distances of the order of a meter. A trigger requiring coincidences between nearby photomultiplier tubes should reduce the trigger rate for a neutrino telescope to a manageable level with only a small loss in efficiency.Comment: 18 pages, 8 figures, accepted for publication in Astroparticle Physic

Whole-scalp EEG mapping of somatosensory evoked potentials in macaque monkeys

High-density scalp EEG recordings are widely used to study whole-brain neuronal networks in humans non-invasively. Here, we validate EEG mapping of somatosensory evoked potentials (SSEPs) in macaque monkeys (Macaca fascicularis) for the long-term investigation of large-scale neuronal networks and their reorganisation after lesions requiring a craniotomy. SSEPs were acquired from 33 scalp electrodes in five adult anaesthetized animals after electrical median or tibial nerve stimulation. SSEP scalp potential maps were identified by cluster analysis and identified in individual recordings. A distributed, linear inverse solution was used to estimate the intracortical sources of the scalp potentials. SSEPs were characterised by a sequence of components with unique scalp topographies. Source analysis confirmed that median nerve SSEP component maps were in accordance with the somatotopic organisation of the sensorimotor cortex. Most importantly, SSEP recordings were stable both intra- and interindividually. We aim to apply this method to the study of recovery and reorganisation of large-scale neuronal networks following a focal cortical lesion requiring a craniotomy. As a prerequisite, the present study demonstrated that a 300-mm2 unilateral craniotomy over the sensorimotor cortex necessary to induce a cortical lesion, followed by bone flap repositioning, suture and gap plugging with calcium phosphate cement, did not induce major distortions of the SSEPs. In conclusion, SSEPs can be successfully and reproducibly recorded from high-density EEG caps in macaque monkeys before and after a craniotomy, opening new possibilities for the long-term follow-up of the cortical reorganisation of large-scale networks in macaque monkeys after a cortical lesion

Laparoscopic Redo Surgery in the Gastroesophageal Junction Area

Background: Laparoscopy has become the standard surgical approach in cases of gastroesophageal reflux disease, large paraesophageal hiatal hernia and achalasia, with excellent long-term results and high patient satisfaction. However, several studies have shown that laparoscopic hiatal hernia repair is associated with high recurrence rates. After laparoscopic Heller myotomy some patients still have symptoms and require reoperation. Laparoscopic redo surgery (LRS) for GERD, hiatal hernia or achalasia is still technically challenging and its outcome has not been reported in the country. We report the surgical technique and initial results of LRS for recurrent GERD, hiatal hernia and achalasia.Materials and Methods: Between January, 2006 and January, 2016, 23 redo laparoscopic operations were attempted, 2 for the third time. Indications were: large symptomatic hiatal hernia - 2, hiatal hernia with reflux - 9, hiatal hernia with reflux and dysphagia - 7, hiatal hernia with dysphagia - 3, one patient was reoperated for acute hiatal reherniation and one - for recurrent achalasia.Results: The patients consisted of 15 men and 8 women with a mean age of 59 (range 38-79). The types of primary operations were 19 Nissen, 2 Hill and 1 anterior Fundoplications, and 1 Heller-Dor procedure. In 3 cases meshes were used. The average interval from the primary surgery was 26.5 (range 1-120) months. Laparoscopic surgery was performed on 22 patients and one conversion occured. Fundoplication was left in place in 5 patients. It was redone in 12 (2 were slipped) and five patients were converted from Nissen to Toupet fundoplication since floppy. Nissen could not be performed properly because of thickened gastric fundus. Cruroplasty was performed in all of the cases. One patient required a 3rd operation for recurrence after redo fundoplication. The operation time was 230±65min. (70 - 300 min.) Soft diet started on the first POD and the post-operative stay was 3.7 days. Intraoperative complications occurred in 17.4 % of patients (gastric perforation - 2, esophageal perforation - 1, pneumothorax requiring chest tubes: 1. One patient died on POD 2. With a median follow-up period of 42 months, 22 patients have been without recurrence and 1 patient was reoperated.Conclusion: Laparoscopic redo surgery for recurrent GERD, hiatal hernia or achalasia is feasible and effective and can be attempted in all cases

Laparoendoscopic Single-Site Surgery (LESS) in Totally Extraperitoneal (TEP) Inguinal Hernia Repair: Initial Experience

Background: Laparoscopic inguinal hernia repair was introduced in the early 1990s. A novel surgical approach known as laparoendoscopic single-site surgery (LESS) has been developed to reduce the port-related morbidities and improve the cosmetic outcomes of laparoscopic surgery, including totally extraperitoneal (TEP) inguinal hernia repair.The aim of the this study is to present our initial experience with LESS TEP.Materials and Methods: Between April, 2013 and January, 2016, 21 healthy patients (18 men and 3 women) underwent LESS TEP inguinal hernia repair performed by the same surgical team. The first 5 procedures were performed using Covidien SILS port for simultaneous passage of the laparoscope and the instruments. All of the other surgeries were performed using Karl Storz Curcillo trocars, passed trough a single incision. The perioperative data, including patient age, sex, body mass index (BMI), hernia characteristics, operative time, complications, length of hospital stay, return to normal activity, pain score, and cosmetic results, were prospectively collected.Results: Twenty LESS TEP procedures were completed successfully and one had to be converted to a standard 3 port laparoscopic surgery, because of a peritoneal breach.The mean operative time was significantly shorter in the standard TEP series (61.8±26.0 vs. 105.9±23.8 min.). There were no complications. The average hospital stay was 1.3 days.Conclusion: Our short-term experience with LESS TEP inguinal hernia repair has shown that in experienced hands, inguinal hernia repair via the LESS TEP technique is as safe as the standard TEP technique. But the question whether is it worth still remains