Pancreatic complications following orthotopic liver transplantation

During fiscal year 1986, 40 out of 196 patients (21%) developed hyperamylasemia following orthotopic liver transplantation. The placement of a retropancreatic aortohepatic arterial interposition graft was associated with hyperamylasemia (p < 0.025). Eight patients (20%) developed clinically significant acute pancreatitis and its sequelae; abscesses and pseudocysts each in 2. Pancreatitis was attributable to the retropancreatic arterial graft in 4, viral infection in 2 and obstruction of the pancreatic duct in 1 patient. All 4 patients with arterial graft-related pancreatitis exhibited poor graft function immediately postoperatively, of whom 2 required retransplantation - both of which failed to function. Five patients died (63%); 2 from primary graft non-function, 2 due to sepsis and 1 from systemic cytomegalovirus infection. We conclude that acute pancreatitis after liver transplantation is a life-threatening complication which is often associated with graft non-function

Are serial CA 19-9 kinetics helpful in predicting survival in patients with advanced or metastatic pancreatic cancer treated with gemcitabine and cisplatin?

Background: Serial kinetics of serum CA 19-9 levels have been reported to reflect response and survival in patients with pancreatic cancer undergoing surgery, radiotherapy, and chemotherapy. We prospectively studied serial kinetics of serum CA 19-9 levels of patients with locally advanced or metastatic disease treated with gemcitabine and cisplatin. Patients and Methods: Enrolled in the study were 87 patients (female/male = 26/61; stage III/IV disease = 24/63). Patients received gemcitabine 1,000 mg/m(2) on days 1, 8, and 15 plus cisplatin 50 mg/m(2) on days 1 and 15, every 4 weeks. Serum samples were collected at the onset of chemotherapy and before the start of a new treatment cycle (day 28). Results: 77 of 87 patients (88.5%) with initially elevated CA 19-9 levels were included for evaluation. According to imaging criteria, 4 (5.2%) achieved a complete remission and 11 (14.3%) achieved partial remission, yielding an overall response rate of 19.5%. 43 (55.8%) patients were CA 19-9 responders, defined by greater than or equal to50% decrease in CA 19-9 serum levels within 2 months after treatment initiation. Except for one, all patients who had responded by imaging criteria (n = 14) fulfilled the criterion of a CA 19-9 responder. Despite being characterized as non-responders by CT-imaging criteria (stable/progressive disease), 29 patients were classified as CA 19-9 responders (positive predictive value 32.5%). Independent of the response evaluation by CT, CA 19-9 responders survived significantly longer than CA 19-9 non-responders (295 d; 95% CI: 285-445 vs. 174 d; 95% CI: 134-198; p = 0.022). Conclusion: CA 19-9 kinetics in serum serve as an early and reliable indicator of response and help to predict survival in patients with advanced pancreatic cancer receiving effective treatment with gemcitabine and cisplatin

Competing superconducting and magnetic order parameters and field-induced magnetism in electron doped Ba(Fe1−x_{1-x}Cox_{x})2_{2}As2_{2}

We have studied the magnetic and superconducting properties of Ba(Fe$_{0.95}$Co$_{0.05}$)$_{2}$As$_{2}$ as a function of temperature and external magnetic field using neutron scattering and muon spin rotation. Below the superconducting transition temperature the magnetic and superconducting order parameters coexist and compete. A magnetic field can significantly enhance the magnetic scattering in the superconducting state, roughly doubling the Bragg intensity at 13.5 T. We perform a microscopic modelling of the data by use of a five-band Hamiltonian relevant to iron pnictides. In the superconducting state, vortices can slow down and freeze spin fluctuations locally. When such regions couple they result in a long-range ordered antiferromagnetic phase producing the enhanced magnetic elastic scattering in agreement with experiments.Comment: 9 pages, 6 figure

Reports from the Fifth EAHN Meeting in Tallinn

The fifth international meeting of the European Architectural History Network was held in Tallinn, at the National Library of Estonia, from 13 to 16 June 2018. The reports from this meeting aim to capture some of the main themes that came up during four intense days of academic discussions and exchange, meetings, and free-form interaction in different spatial and social settings. After the introduction by Andres Kurg, host of the Tallinn Meeting, five delegates review the five thematic tracks which organised the selected sessions and ran in parallel throughout the three days of the conference: Mediations, Comparative Modernities, Peripheries, Discovery and Persistence, and Body and Mind. In his closing keynote lecture, Reinhold Martin from Columbia University further reflected on the ample critical discussions which had taken place throughout the conference

A prospective randomized trial comparing sequential ganciclovir-high dose acyclovir to high dose acyclovir for prevention of cytomegalovirus disease in adult liver transplant recipients

Cytomegalovirus disease is an important cause of morbidity following liver transplantation. To date there has not been an effective prophylaxis for CMV disease after liver transplantation. One hundred forty-three patients were randomized to receive either high dose oral acyclovir (800 mg 4 times a day) alone for 3 months after transplantation (acyclovir group) or intravenous ganciclovir (5 mg/kg twice a day) for 14 days followed by high dose oral acyclovir to complete a 3-month regimen (ganciclovir group). Of 139 patients available for evaluation, 43 of 71 (61%) patients from the acyclovir group developed CMV infection compared with 16 of 68 (24%) from the ganciclovir group (relative risk, 3.69; 95% confidence interval, 2.07-6.56; PcO.OOOOl). Of those randomized, CMV disease was seen in 20 (28%) of the acyclovir group compared with 6 (9%) of the ganciclovir group (relative risk, 5.11; 95% confidence interval, 2.05-12.75; P=0.0001). The median time to onset of CMV infection was 45 days in the acyclovir group compared with 78 days in the ganciclovir group (P=0.004). The median time to onset of CMV disease was 40 days in the acyclovir group compared with 78 days in the ganciclovir patients (P=0.02). With respect to primary CMV infection, there was no difference in the rates in the 2 groups, but tissue invasive disease and recurrent CMV disease were less frequent in the ganciclovir group. It is concluded that a course of 2 weeks of ganciclovir immediately after transplantation followed by high dose oral acyclovir for 10 weeks is superior to a 12-week course of high dose oral acyclovir alone for prevention of both CMV infection and CMV disease after liver transplantation. However, the lack of significant effect in seronegative recipients who received grafts from seropositive donors suggests that other strategies are needed to prevent CMV infection in this high risk population. © 1994 by Williams & Wilkins

Sinnvoller Einsatz von Tumormarkern

Tumor markers refer to all detectable and measurable analytes which are able to indicate a solid tumor or contribute to its characterization or judgment concerning tumor spread and therapy efficacy. Among the markers, humoral circulating tumor substances, such as precursors of normal antigens, ectopically produced hormones or enzymes, ontogenetic old reactivated antigens, hybridoma-defined mucins and cytokeratins are of special interest. Up to now, no tumor specific biomarker has been detected, all markers known so far are physiological components of blood; thus, their diagnostic capacity is more related to quantity than to quality. The tumor marker concentration depends on the tumor blood supply and reflects tumor mass and tumor spread as a sum of marker expression, synthesis, release, the catabolism of the organism, as well as the marker excretion. Changes in biomarker levels without correlation to tumor load can be due to impairment of the liver and kidney function or due to invasive diagnostic methods (endoscopy, biopsy, ureteral catheter) or due to acute reactions on treatment (surgery, radio-chemotherapy). Due to problems with standardization between assays from different producers measuring the same antigen, interpretation of biomarkers of single measurements, such as PSA (prostate specific antigen), must be performed using assay specific reference ranges and interpretation of serial measurements must be performed using the identical assay. The test result has to be indicated together with the assay used (kit and producer). Among the potential indications for tumor marker determinations, the early detection or screening of a tumor is unrealistic - except PSA in prostate cancer detection. In rare cases, biomarkers can be helpful in tumor localization (HTG (human thyreoglobuline), PSA) and support of primary diagnosis, the knowledge about their prognostic relevance is increasing, the most widely used indication is therapy control and follow-up care in context with medical imaging. Provided that markers are critically selected following the localization of the tumor, that serial determinations are performed using the identical assay and that the clinical question is relevant, tumor markers contribute to a significant degree to diagnosis, prognosis, therapy control and early detection of metastatic or recurrent disease. Especially in the field of diagnostic oncology, the quality of the investigator is significantly linked to the quality of the test result