New criteria for liver transplantation in adults: the combined Groningen and Rotterdam protocol.
Division of Gastroenterology and Hepatology, University Hospital Groningen, Netherlands. P.L.M.Jansen@med.reg.nl
A combined protocol for liver transplantation has been written by the teams of Groningen and Rotterdam. This is to ensure that the criteria for selection and timing of liver transplantation, and the procedures for patient evaluation, are identical or at least very similar. Also, the waiting list procedures in the two centres, including the criteria used to decide which patient will be transplanted first, are very similar. Currently, most patients with liver cirrhosis or filminant liver failure should be considered as liver transplant candidates unless a contraindication is found. Most contraindications are relative and are the subject of a careful balance of pros and cons. The detection and care of liver patients starts with the general practitioner. Referral to liver transplantation centres is the final step. In the Netherlands, liver disease is relatively rare and therefore patients are best served when the expertise is concentrated in a few liver centres.
Aortic graft infection by Lactobacillus casei: a case report.
Schoon Y. Schuurman B. Buiting AG. Kranendonk SE. Graafsma SJ.
Department of Internal Medicine, TweeSteden Ziekenhuis, Tilburg, Netherlands.
A 65-year-old man with an abdominal aortic endoprosthesis presented with fever without other symptoms. Investigations revealed Lactobacillus casei bacteraemia. The Lactobacillus graft infection was at first successfully treated by antibiotic therapy. However, during follow-up a relapse occurred, and after surgical replacement of the graft the patient was cured. At surgery an aortoenteric fistula was found as source of the infection.
Hypereosinophilic syndrome presenting with diarrhoea and anaemia in a patient with systemic lupus erythematosus.
Markusse HM. Schravenhoff R. Beerman H.
Department of Rheumatology, Zuiderziekenhuis, Rotterdam, Netherlands.
We describe a patient with quiet systemic lupus erythematosus who developed a hypereosinophilic syndrome. The patient presented with gastrointestinal eosinophilia which caused diarrhoea, malabsorption and anaemia due to deficiencies of vitamins. The hypereosiniphilic syndrome completely resolved after treatment with prednisone.
Acquired angio-oedema caused by IgA paraprotein.
van Spronsen DJ. Hoorntje SJ. Hannema AJ. Hack CE.
Department of Internal Medicine, Catharina Hospital, Eindhoven, Netherlands. firstname.lastname@example.org
The syndrome of acquired angio-oedema is characterized by late onset of recurrent bouts of angio-oedema or abdominal pain and may be caused by an acquired deficiency of C1-inhibitor (C1-INH), the inhibitor of the first component of complement. Acquired C1-INH deficiency has been described in approximately 50 patients and is strongly associated with malignant B-cell proliferations. We describe a patient with an 8-year history of recurrent abdominal symptoms and angio-oedema with acquired C1-INH deficiency, caused by the presence of IgA-kappa antibodies that inactivate C1-INH. Analysis of the bone marrow revealed an IgA-kappa monoclonal population of plasma cells, without evidence of overt myeloma. Angio-oedema caused by an autoantibody of the IgA isotype is extremely rare and has never been described in a Dutch patient. Recognition of angio-oedema, both hereditary and acquired, is important because of the therapeutic consequences, as will be discussed.