University Hospital Rotterdam Research Articles

Development of a Connected Sensor System in Colorectal Surgery: User-Centered Design Case Study.

BackgroundA successful innovative medical device is not only technically challenging to develop but must also be readily usable to be integrated into health care professionals’ daily practice. Through a user-centered design (UCD) approach, usability can be improved. However, this type of approach is not widely implemented from the early stages of medical device development.ObjectiveThe case study presented here shows how UCD may be applied at the very early stage of the design of a disruptive medical device used in a complex hospital environment, while no functional device is available yet. The device under study is a connected sensor system to detect colorectal anastomotic leakage, the most detrimental complication following colorectal surgery, which has a high medical cost. We also aimed to provide usability guidelines for the initial design of other innovative medical devices.MethodsUCD was implemented by actively involving health care professionals and all the industrial partners of the project. The methodology was conducted in 2 European hospitals: Grenoble-Alpes University Hospital (France) and Erasmus Medical Center Rotterdam (the Netherlands). A total of 6 elective colorectal procedures and 5 ward shifts were observed. In total, 4 workshops were conducted with project partners and clinicians. A formative evaluation was performed based on 5 usability tests using nonfunctional prototype systems. The case study was completed within 12 months.ResultsFunctional specifications were defined for the various components of the medical device: device weight, size, design, device attachment, and display module. These specifications consider the future integration of the medical device into current clinical practice (for use in an operating room and patient follow-up inside the hospital) and interactions between surgeons, nurses, nurse assistants, and patients. By avoiding irrelevant technical development, this approach helps to promote cost-effective design.ConclusionsThis paper presents the successful deployment over 12 months of a UCD methodology for the design of an innovative medical device during its early development phase. To help in reusing this methodology to design other innovative medical devices, we suggested best practices based on this case.

ERJ November Podcast: Macrolides in severe asthma.

As part of the November issue, the European Respiratory Journal presents the latest in its series of podcasts. Deputy Chief Editor James Chalmers interviews Sarah Hiles (University of Newcastle, Callaghan, Australia), Peter Gibson (University of Newcastle, Callaghan, and John Hunter Hospital, New Lambton Heights, Australia) and Guy Brusselle (Ghent University Hospital, Ghent, Belgium, and Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands) about their individual patient data meta-analysis of the use of azithromycin in severe asthma published in this issue.

Microcirculation in women with severe pre‐eclampsia and HELLP syndrome: a case–control study

To compare microcirculatory perfusion in women with severe pre-eclampsia against that in healthy pregnant women, and secondly in women with severe pre-eclampsia with or without HELLP syndrome (haemolysis, elevated liver enzymes, and low platelets). Case-control study. University Hospital Rotterdam, the Netherlands. Twenty-three women with severe pre-eclampsia and 23 healthy pregnant controls, matched for maternal and gestational age. Out of the 23 women with severe pre-eclampsia, ten presented with HELLP syndrome. Microcirculation was analysed sublingually by a non-invasive sidestream dark-field imaging device (SDF). Perfused vessel density (PVD), microcirculatory flow index (MFI), and heterogeneity index (HI) were calculated for both small vessels (∅ < 20 μm; capillaries) and non-small vessels (∅ > 20 μm; venules and arterioles). There were no significant differences between women with severe pre-eclampsia and healthy controls. Women with pre-eclampsia and HELLP syndrome showed a reduced PVD (P = 0.045), MFI (P = 0.008), and increased HI (P = 0.002) for small vessels, as compared with women with pre-eclampsia but without HELLP syndrome. Sidestream dark-field is a novel, promising technique in obstetrics that permits the non-invasive evaluation of microcirculation. We did not observe major differences in sublingual microcirculatory perfusion between women with severe pre-eclampsia and healthy pregnant controls. In women with severe pre-eclampsia, the presence of HELLP syndrome is characterised by impaired capillary perfusion.

Idiopathic noncirrhotic intrahepatic portal hypertension is an ongoing problem in India

We would like to thank Goel et al. for their reply to our review of idiopathic noncirrhotic portal hypertension (INCPH).1, 2 The authors studied the prevalence of INCPH among all new portal hypertension patients from July 2009 until July 2010. Eventually, 17 (39%) patients were diagnosed with INCPH. The authors described the morphological features observed in liver specimens from these 17 INCPH patients. Interestingly, neither the presence of nodular regenerative hyperplasia nor obliteration of portal venules (phlebosclerosis)—both the most frequently observed morphological features in liver specimens of Western INCPH patients—were found.3, 4 The apparent absence of these features in Indian INCPH patients could imply differences in pathophysiological mechanisms between patients from different continents. As reported by Goel et al., liver biopsy is mandatory in the diagnosis of INCPH. Its main role is the exclusion of liver cirrhosis, which may be very difficult to discern by radiological examinations only. In addition, the diagnosis of INCPH can be suggested or supported by the presence of morphological features such as nodular regenerative hyperplasia, phlebosclerosis, increased number of portal vascular channels, paraportal shunt vessels, and sinusoidal dilatation. However, one must take into account that these features can also be observed in patients without clinical signs of portal hypertension. J.N.L. Schouten M.D.*, H.L.A. Janssen Ph.D.*, * Department of Gastroenterology Hepatology, University Hospital Rotterdam, Rotterdam, The Netherlands.

The incidence of traumatic brain injury in young people in the catchment area of the University Hospital Rotterdam, The Netherlands

Background Traumatic brain injury (TBI) is in the developed countries the most common cause of death and disability in childhood. Aim The purpose of this study is to estimate the incidence of TBI for children and young people in an urbanised region of the Netherlands and to describe relevant characteristics of this group. Methods Patients, aged 1 month - 24 years who presented with traumatic brain injury at the Erasmus University Hospital (including the Sophia Children’s Hospital) in 2007 and 2008 were included in a retrospective study. Data were collected by means of diagnosis codes and search terms for TBI in patient records. The incidence of TBI in the different referral areas of the hospital for standard, specialised and intensive patient care was estimated. Results 472 patients met the inclusion criteria. The severity of the Injury was classified as mild in 342 patients, moderate in 50 patients and severe in 80 patients. The total incidence of traumatic brain injury in the referral area of the Erasmus University Hospital was estimated at 113.9 young people per 100.000. The incidence for mild traumatic brain injury was estimated at 104.4 young people, for moderate 6.1 and for severe 3.4 young people per 100.000. Conclusion The ratio for mild, moderate and severe traumatic brain injury in children and young people was 33.7–1.8–1.In the mild TBI group almost 17% of the patients reported sequelae. The finding that 42% of them had a normal brain CT scan at admission underwrites the necessity of careful follow up of children and young people with mild TBI.

Bone age assessment by dual-energy X-ray absorptiometry in children: an alternative for X-ray?

The aim of the study was to validate dual-energy X-ray absorptiometry (DXA) as a method to assess bone age in children. Paired dual-energy X-ray absorptiometry (DXA) scans and X-rays of the left hand were performed in 95 children who attended the paediatric endocrinology outpatient clinic of University Hospital Rotterdam, the Netherlands. We compared bone age assessments by DXA scan with those performed by X-ray. Bone age assessment was performed by two blinded observers according to the reference method of Greulich and Pyle. Intra-observer and interobserver reproducibility were investigated using the intraclass correlation coefficient (ICC), and agreement was tested using Bland and Altman plots. The intra-observer ICCs for both observers were 0.997 and 0.991 for X-ray and 0.993 and 0.987 for DXA assessments. The interobserver ICC was 0.993 and 0.991 for X-ray and DXA assessments, respectively. The mean difference between bone age assessed by X-ray and DXA was 0.11 years. The limits of agreement ranged from -0.82 to 1.05 years, which means that 95% of all differences between the methods were covered by this range. Results of bone age assessment by DXA scan are similar to those obtained by X-ray. The DXA method seems to be an alternative for assessing bone age in a paediatric hospital-based population.

Impact of disease severity on outcome of antiviral therapy in treatment‐naïve patients with chronic hepatitis C†

We read with interest the article by Everson et al.1 The authors convincingly demonstrate that disease severity, as measured by both degree of liver fibrosis and platelet count, has a major impact on the rate of sustained viral response (SVR) following therapy with peginterferon α-2a and ribavirin among patients with advanced chronic HCV infection who have formerly not responded to interferon therapy. Previous reports indicate SVR rates of 43%–75% among treatment-naïve patients with cirrhosis and/or bridging fibrosis after combination therapy with peginterferon and ribavirin,2-4 with the highest response rates noted among patients infected with genotypes 2 or 3.3 The impact of portal hypertension with splenomegaly as reflected by the platelet count was, however, not reported in these studies. In a European HCV multicenter treatment study,5 we treated 270 treatment-naïve HCV-infected patients with peginterferon α-2a and ribavirin. Eighty of these patients had either bridging fibrosis (Ishak stage 3–4) or cirrhosis (Ishak stage 5–6) in their pretreatment liver biopsies. Their SVR rates with regards to genotype and baseline platelet counts and fibrosis stage are summarized in Table 1. Interestingly, patients infected with genotype 1 who had both bridging fibrosis and platelet count ≤125,000/mm3 achieved SVR, compared to none of 5 patients infected with genotype 1 who had cirrhosis and low platelet count (P = 0.0476, Fisher's exact test). Disease severity, however, had less impact on SVR among patients infected with genotypes 2 or 3. In conclusion, these findings support the results presented by Everson et al. that disease severity as measured by both fibrosis stage and platelet count is a major determinant of treatment outcome in patients with advanced chronic hepatitis C, especially those infected with genotype 1, even in patients previously naïve to treatment. Johan Westin*, Kristoffer Hellstrand*, Åsa Alsiö*, Magdalena Ydreborg*, Carlo Ferrari , Avidan U. Neumann , Jean-Michel Pawlotsky?, Solko W. Schalm?, Stefan Zeuzem**, Elke Verhey-Hart?, Martin Lagging*, * Department of Infectious Diseases, University of Göteborg, Sweden, Azienda Ospedaliera di Parma, Parma, Italy, Bar-Ilan University, Ramat-Gan, Israel, ? Hôpital Henri Mondor—Université Paris XII, Creteil, France, ? University Hospital Rotterdam Dijkzigt, Rotterdam, The Netherlands, ** Saarland University Hospital, Homburg/Saar, Germany.

The Effect of Infant Orthopedics on the Occlusion of the Deciduous Dentition in Children with Complete Unilateral Cleft Lip and Palate (Dutchcleft)

Evaluation of the effect of infant orthopedics (IO) on the occlusion of the deciduous dentition in patients with unilateral cleft lip and palate (UCLP). Prospective, two-arm, randomized, controlled clinical trial with three participating cleft palate centers (Dutchcleft). Cleft Palate Centers of the University Medical Center Nijmegen, Academic Center of Dentistry Amsterdam, and Dijkzigt University Hospital Rotterdam, The Netherlands. Children with complete UCLP (n = 54) were included. In a concealed allocation procedure, half of the patients was randomized to wear a plate till surgical closure of the soft palate (IO+), and the other half (IO-) did not have a plate. Dental arch relationships were assessed at 4 and 6 years of age with the 5-year-old index; the Huddart-score; and measurements of overjet, overbite, and sagittal occlusion. There were no significant differences found between the IO+ and IO- groups for the 5-year-old index; the Huddart-score; and overjet, overbite, and sagittal occlusion. IO had no observable effect on the occlusion in the deciduous dentition at 4 and 6 years of age. Considering the occlusion only, there is no need to perform IO in children with UCLP.

Quality of care from the perspective of the cataract patient: QUOTE cataract questionnaire

Purpose To examine the potential of a questionnaire (QUOTE Cataract) to measure quality of care from the perspective of cataract patients in quality-assurance or improvement programs. Setting Department of Ophthalmology, University Hospital Maastricht, Maastricht, University Hospital Groningen, Groningen, and Rotterdam Eye Hospital, Rotterdam, The Netherlands. Methods Cataract patients (N = 540) who had cataract surgery 2 to 8 months previously rated 31 quality-of-care aspects in terms of importance (range 0, not important, to 10, extremely important) and performance (0 = yes, 1 = no). An arithmetic combination of the 2 parameters was used to generate quality-impact factors (Q) (range 0, best quality of care, to 10, this aspect needs improvement according to every respondent). The goal was to identify bottlenecks in the quality of care. Results Patients scored aspects concerning patient education as the most important quality aspects. The top 3 quality-impact factors were to inform patients what to do in emergency situations (Q = 3.39), inform patients about the risks of treatment (Q = 3.00), and minimize the number of ophthalmologists to 1 per patient (Q = 2.79). Conclusion The QUOTE Cataract Questionnaire effectively measured quality of care in cataract surgery patients in different hospital settings and provided practical information for quality-assurance programs.

Questionnaire as diagnostic tool in chronic pelvic pain (CPP): a pilot study

Objectives: No standard screening instrument is available enabling physicians to assign the diagnosis chronic pelvic pain (CPP) to women with lower abdominal pain. Therefore, our aim was to evaluate an easy-to-use questionnaire, which can be applied as a validated primary screening test for diagnosing CPP. Study design: From the general female population, 577 women completed a questionnaire addressing chronic symptoms in the pelvic region. Included were (amongst others) questions on lower abdominal pain, low back pain, voiding symptoms, dyspareunia, pelveo-perineal dysesthetic feelings and evacuation problems. Serious chronic lower abdominal pain of unknown origin was considered as CPP. Three criteria were applied to validate the questionnaire: construct validity, comparison with results of a previous study and content validity. In addition, the internal consistency was checked to ascertain the reliability of the questionnaire. Results: All items, with the exception of those concerning voiding symptoms and dyspareunia, withstood the validity tests applied, were interrelated and occurred significantly more often in women with CPP than those without. There were no significant differences in the frequency of the occurrence of low back pain, dyspareunia and evacuation problems between CPP women in the current community study and outpatients diagnosed with CPP in an earlier study performed at the University Hospital Rotterdam. Compared to our current study group, pelveo-perineal dysesthesia (PPD) and voiding symptoms were significantly more often reported by the CPP outpatients. Conclusion: The CPP questionnaire can be considered as a validated tool for primary screening of CPP.

CO2 laser treatment of Zenker's diverticula

Introduction. Evaluation of the results of endoscopic CO2 laser treatment of Zenker's diverticula. Methods. The records of all patients treated in the University Hospital Rotterdam between 1990 and 1996 using CO2 laser surgery or electrocautery (when CO2 laser was impossible because of technical reasons) for a Zenker's diverticulum were studied. Results. One hundred and eighty-three patients were treated for a Zenker's diverticulum, 179 times using CO2 laser and 42 times using electrocautery. In 29 patients, two or more treatments were needed. Twenty-five complications occurred, five severe and 20 mild. One patient died and in one patient the recurrent laryngeal nerve was damaged; the other patients made full recoveries. Conclusion. CO2 laser surgery is a safe and effective method of treatment for Zenker's diverticula.

Multidrug resistance in haematological malignancies

Abstract. Sonneveld P (University Hospital Rotterdam – Dijkzigt, The Netherlands). Multidrug resistance in haematological malignancies (Internal Medicine in the 21st Century). J Intern Med 2000; 247: 521–534.The development of refractory disease in acute myeloid or lymphoblastic leukaemias (AML, ALL) and multiple myeloma (MM) is frequently associated with the expression of one or several multidrug resistance (MDR) genes. MDR1, MRP1 and LRP have been identified as important adverse prognostic factors in AML, T‐ALL and MM. Recently, it has become possible to reverse clinical multidrug resistance by blocking P‐glycoprotein‐mediated drug efflux. The potential relevance of these reversal agents of MDR and potential new approaches to treat refractory disease are discussed.

Minor myocardial damage and prognosis: Are spontaneous and percutaneous coronary intervention-related events different? Martijn Akkerhuis, John H. Alexander, Barbara E. Tardiff, Eric Boersma, Robert A. Harrington, Michael Lincoff, Maarten L. Simoons. Thoraxcenter, University Hospital Rotterdam, Rotterdam, The Netherlands

Minor myocardial damage and prognosis: Are spontaneous and percutaneous coronary intervention-related events different? Martijn Akkerhuis, John H. Alexander, Barbara E. Tardiff, Eric Boersma, Robert A. Harrington, Michael Lincoff, Maarten L. Simoons. Thoraxcenter, University Hospital Rotterdam, Rotterdam, The Netherlands

CO2-laser treatment of recurrent glottic carcinoma.

Evaluation of the results of CO2 laser treatment of recurrent glottic carcinoma after radiotherapy. Records of all patients treated in the University Hospital Rotterdam and the Dr. Daniel den Hoed Cancer Center between 1980 and 1996 by CO2 laser for recurrent glottic carcinoma were studied. Forty patients were treated by laser surgery. Average follow-up was 77 months. Twenty-three patients (58%) had another recurrence develop after laser surgery. Three were cured by a second laser procedure. Therefore, 20 patients (50%) were successfully treated with laser surgery. In 23 patients the recurrence did not extend into the anterior commissure; in 57% a total laryngectomy could be avoided. In 17 patients the recurrence did extend into the anterior commissure; in 41% a total laryngectomy was avoided. Most patients with recurrent carcinoma of the larynx after radiotherapy can be cured by laser surgery if the tumor does not extend into the anterior commissure.

Magnetic resonance in the diagnosis of renal masses.

BJU InternationalVolume 86, Issue s1 p. 58-69 Magnetic resonance in the diagnosis of renal masses J.J. Nikken, J.J. Nikken Department of Radiology, University Hospital Rotterdam, Dijkzigt, The NetherlandsSearch for more papers by this authorG.P. Krestin, G.P. Krestin Department of Radiology, University Hospital Rotterdam, Dijkzigt, The NetherlandsSearch for more papers by this author J.J. Nikken, J.J. Nikken Department of Radiology, University Hospital Rotterdam, Dijkzigt, The NetherlandsSearch for more papers by this authorG.P. Krestin, G.P. Krestin Department of Radiology, University Hospital Rotterdam, Dijkzigt, The NetherlandsSearch for more papers by this author First published: 02 January 2002 https://doi.org/10.1046/j.1464-410X.2000.00582.xCitations: 3 J.J. Nikken, Department of Radiology, University Hospital, Erasmus University Rotterdam, The Netherlands. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume86, Issues1July 2000Pages 58-69 RelatedInformation

Development of a real-time quantitative RT-PCR for the detection of HIV-2 RNA in plasma

An assay is described for the quantification of human immunodeficiency virus type 2 (HIV-2) RNA in EDTA plasma based on RT-PCR using the Taqman real-time PCR detection method. As standard, an electron microscopically counted virus stock of HIV-2 strain NIHZ was used. The lower detection limit is 5#102 HIV-2 RNA copies per ml of EDTA plasma. The assay is linear within the range required (5#102-106 HIV-2 RNA copies/ml of EDTA plasma) with an intra assay variability of 2.5% and an inter-assay variability ranging from 2% at 106 copies to 7.5% at the lower detection limit. Three primer/probe combinations were developed to circumvent false negative samples due to nucleotide variation in the target sequence. Using these primer/probe sets enabled the detection of HIV-2 DNA sequences from all HIV-2 seropositive individuals and two out of five dual human immunodeficiency virus type 1 (HIV-1) and HIV-2 seropositive individuals visiting the University Hospital Rotterdam.

Intravenous monoclonal anti-HBS (m-anti-HBs) in chronic hepatitis B (HBV) patients treated with lamivudine

INTRAVENOUS MONOCLONAL ANTI-HBS (m-anti-HBs) IN CHRONIC HEPATITIS B (HBV) PATIENTS TREATED WITH LAMIVUDINE A.B. van Nunen l, R.A. de Man I, R.A. Heijtink 2, S.W. Schalm l 1Dept. of Hepatogastroenterology, University Hospital Rotterdam, The Netherlands. 2Dept. of Virology, University Hospital Rotterdam, The Netherlands. M-anti-HBs is a human monoclonal antibody, which recogniscs the stable adeterminant of HBsAg. The binding of m-anli-I-IBs to HBsAg is 200-fold higher than of HBIg, Anti-FIBs has been used successfully for virus neutralisation following liver transplantation. Furthermore it may have some immunostimulatory effects. We evaluated the safety and efficacy of m-anti-FIBs in lamivudine-treated chronic I-IBV patients during maximal virus suppression. Methods: Nine patients were included (7~. 2~). At screening 6/9 were HBV DNA negative by PCR, in 3 patients I-IBV DNA was detectable only by quantitative PCR techniques (QPCR), median (range) trealment with lamivudine was 35 (10-53) weeks. ALT was slightly devat~ in one patient. Patients received 8 gifts of m-anti-HBs over 2 weeks in a dose escalating way (20-20-40-40-80-80 mR) to reduc© possible side-effects due to the formation of insoluble immun¢complexes. Follow-up was 2 weeks. Neutralisation of HBsAg was mimick~ in an in solution assay CHeijtink et al). HBsAg and anti-FIBs were measured quantitatively by an experimental EIA. Results: In 2 patients a m-anti-HBs-related anaphylantie reaction occurred leading to withdrawal of therapy in 1 patient. This patient was excluded from further analysis of eftieany. In vitro m-anti-ttBs antibodies were partially effective in neutralisation of HBsAg. Depending on the monoelonsi antibody used at the solid phase a maximum percentage inhibition around 800 was obtained. During treatment HBsAg significantly declined. Median (range) HBsAg levels dropped from 2,24 (0,49-19,84) p.8/ml to 0,65 (0,01-14,08) Ixg/ml at end of foUow up (EFLD (Wilcoxon signed rank, p 90% decline was observed at EFU. M-anti-FIBs was still detectable at EFU in all patients varying between 0,04 and 8,8 lag/ml. One month after the EFU in all patients m-anti-HBs was undeteetable, two months later HBsAg had returned to pretreatment levels again. Conclusions: In 2/9 patients a SAE oceurred, leading to withdrawal of therapy in 1 patient. M-anti-HBs was only partially effective in binding HBsAg in this neutralisation assay. HBsAg declined significantly during therapy with m-enti-HBs and anti-HBs levels remained detectable until EFU. However no long-term effects were observed. Viral hepatitis: clinical aspects

Do older hospital patients recognize adverse drug reactions?

To establish the relationship between subjective complaints of side effects of drugs and the objective presence of adverse drug reactions in older patients. Observational cross-sectional study. Five medical wards at the University Hospital Rotterdam Dijkzigt. Patients aged 70 and over admitted to the general medical wards over a 3-month period. Statistical comparison and Kramer's algorithm. Of 106 patients, 102 used medication, and 93 of these were able to report whether they believed they were experiencing drug side effects. Thirty-six [39% (95% confidence interval 28.8-48.6)] believed that they were experiencing side effects and the number of diagnoses per patient and the proportion of patients with chronic obstructive pulmonary disease was higher in these 36 'complainers' than in the group of the 'non-complainers'. We found a correct opinion (true positive and negative) about the objective presence or absence of mild or severe adverse drug reactions in 79% (95% confidence interval 70.2-86.8). Asking the patient about side effects of drugs had a sensitivity of 0.70 and a specificity of 0.85 patients. The severe adverse drug reactions in 21 patients were not recognized by 14 of them. At hospital admission, older patients should be asked about drug side effects because they are often correct in recognizing them. However, severe adverse drug reactions are not easily recognized.

Are donor-livers with low expression of CD80 at the time oftransplantation less susceptible to acute rejection?

ARE DONOR-LIVERS WITH LOW EXPRESSION OF CD80 AT THE TIME OF TRANSPLANTATION LESS SUSCEPTIBLE TO ACUTE REJECTION? J. Kwekkeboom, B. Bruyneel, H.W. Tilanus, J.N.M. Ijzermans, G.J. Bouma, P.E. Zondervan, H.J. Metselaar Liver Transplantation Research Group, Departments of Hepatogastroenterology, Surgery and Pathology, University Hospital Rotterdam, The Netherlands. We investigated the impact of per-operative expression of ¢o-stimulatory molecules in clinical liver-transplants on the occurrence of acute rejection. CD80 and CD86 expression were determined by immunohistochemistry on cryostate sections of three biopsies taken from each liver during transplantation: after the cold ischemie period, after the warm ischemic period and after reperfusion. CD86 was expressed in all livers on the majority of CD68+-Kupffer cells and in 12/15 livers on peri-vascular cells in the portal areas. CD80 was weakly expressed in the portal areas of only 6/15 livers. Expression of CDS0 on Kupffer cells was variable and appeared to be related to the occurrence of rejection. In 7/8 livers which were not rejected, CD80 was expressed on 0%-25% of the Kupffer cells. In 4/7 livers which were rejected CD80 was expressed on 50%-100% and in 2/7 on 25%,50% of the Kupffer cells. Since infiltrating T-cells in rejection-biopsies expressed abundant CD28 but nearly no CTLA-4, the CD80/CD86-signals delivered by the donor-liver will be stimulatory for the infiltrating T-cells. Conclusion: donor-livers with low CD80 expression on Kupffer cells at the time of transplantation seem to be less susceptible to acute rejection. Liver transplantation, surgery, acute liver failure

No beneficial effects of transdermal nicotine in patients with primary sclerosing cholangitis: Results of a randomized placebo-controlled cross-over study

NO BENEFICIAL EFFECTS OF TRANSDERMAL NICOTINE IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS: RESULTS OF A RANDOMIZED PLACEBO-CONTROLLED CROSS-OVER STUDY EE Vle~aark H.R. van Buuren l, G.E Van Ber~,e Hene~,ouwen 2, W.C.J. Hop 3, K.J. van Erpecum 2 IDept of Hepatogastroenterology, University Hospital Rotterdam, The Netherlands. ZDept of Hepatogastroenterology, University Hospital Utrecht, The Netherlands. 3Dept of Biostatistics, Erasmus University Rotterdam, The Netherlands. Smoking is associated with a decreased risk of primary sclerosing eholangitis. We aimed to explore the therapeutic efficacy and tolerance of transdermal nicotine treatment in this disease. Twelve patients (11 males; 37:~6 years; 6 with ulcerative colitis) without complete biochemical remission on ursodeoxycholic acid (14 mg/kg/day) were treated in a randomised cross-over trial with transdermal nicotine (15 mg/day) or a placebo, each for 8 weeks (4week washout period between treatments). One patient developed de novo ulcerative colitis and two patients did not complete the entire protocol because of intereurrent bacterial cholangitis. Baseline values (mean + range) were: bilirubin 1.3 (0.5-2.6), APt 2.5 (1.4-4.7), gGT 7.7 (0.7-38), AST 1.9 (0.5-3.2), ALT 2.4 (0.4-7.3) and bile salts 10.9 (2.1-39) times the upper limit of normal. No significant effect on pna'itus and fatigue was noted during either period, but a small increase in body-weight was observed during placebo treatment. No significant differences were observed between the two treatment modalities after 8 weeks for bilirubin (nicotine vs placebo: +13% vs 6% change from baseline), APh (-3% vs -17%), gGT (-11% vs -13%), AST (+2% vs -10%), ALT (-1% vs -11%) or bile salts (+36% vs -3%). In conclusion, transdermal nicotine does not seem to have a clear short-term beneficial effect in primary selerosing cholangitis patients treated with ursodeoxycholic acid. Immunology, autoimmune liver disease