Einleitung: Indocyaningrün (ICG) ist ein quantitativer Leberfunktionstest zur Messung der durchblutungsabhängigen Leberfunktion. MELD (model for end-stage liver disease) und Child-Pugh-Score sind als Prognoseparameter bei Patienten mit Zirrhose etabliert. Bei diesen Patienten sind Komplikationen wesentlich mit Veränderungen der Leberdurchblutung (portale Hypertension) assoziiert und durchblutungsabhängige Leberfunktionsteste könnten daher die prognostische Wertigkeit der etablierten Prognoseparameter ergänzen.

8557 Background: To evaluate survival, quality of life and neurotoxic sequelae in long-term survivors with primary central nervous system lymphoma (PCNSL) after systemic and intraventricular chemotherapy with deferred radiotherapy. Patients and Methods: From 09/1995 to 12/2001, 65 patients with PCNSL (median age 62 years) were enrolled in a pilot/phase II study evaluating chemotherapy without radiotherapy; thirty patietns were younger than 60 years. A high-dose methotrexate (MTX) (cycles 1,2,4,5) and cytarabine (ara-C) (cycles 3,6) based systemic therapy (including dexamethasone, vinca-alkaloids, ifosfamide and cyclophosphamide) was combined with intraventricular MTX, prednisolone and ara-C. All living patients were contacted, a neurological examination, comprehensive neuropsychological testing, Quality of Life (QoL) - Assessment (EORTC QLQ-C30 (Version 3.0) und EORTC QLQ-BN20) and imaging were performed. Results: Twenty-one of 65 patients (32 %) are alive. Of these, 17 patients were younger than 60 years at diagnosis, resulting in long-termsurvival rate of 17 of 30 patients (57 %). Median follow up is 99.5 months (range, 70 to 147 months) in surviving patients. Seventeen/21 patients completed all investigations, in three patients test results are pending, one is lost to follow up. One patient is currently undergoing therapy for tumor relapse; one other patient developed a second malignoma (liposarcoma). In three patients, a pure extraneural relapse was diagnosed after nine, 31 and 40 months and showed complete remission to high-dose chemotherapy in all. There was no evidence of late onset neurotoxity nor compromise of therapy- or tumor-related QoL measures in any of the examined patients. Conclusions: Primary polychemotherapy based on high- dose MTX and ara-C is highly efficient in PCNSL. More than half of patients < 60 years can obviously be cured with this regimen without suffering from long term neurotoxic sequelae. No significant financial relationships to disclose.

Background and Aims: Up to recently, oral norfloxacin is the standard of therapy in the prevention of bacterial infection in cirrhosis with gastrointestinal hemorrhage.However, the prevalence of quinolone-resistant bacteria or gram-positive bacteria has been increased constantly during the last years.The purpose of our randomized controlled study was to compare the effectiveness of oral ciprofloxacin versus intravenous ceftriaxone for prevention of bacterial infection in advanced cirrhosis with gastrointestinal hemorrhage.Also, we investigated the influence of intestinal permeability and endotoxin in bacterial infection development.Methods: Of 29 patients who had advanced cirrhosis and hemorrhage, 12 were randomly assigned to receive oral ciprofloxacin (500 mg twice daily for 7 days) and 17 to receive intravenous ceftriaxone (2.0g/day for 7 days).The primary outcome was the prevention of bacterial infection within 10 days after treatment.The secondary outcome included the clinical parameters for association of bacterial infection.Serum endotoxin level was measured by kinetic turbidimetric assay (Microplate reader, Charles River Endosafe ® , USA).Also, Intestinal permeability was assessed by measurement of urinary polyethylene glycol (PEG) after oral ingestion of PEG.Results: Clinical characteristics of enrolled patients were comparable between two groups.The rate of proved and possible infection was significantly higher in ciprofloxacin group than ceftriaxone group (n = 5, 41.7% vs. n = 1, 5.9%, p = 0.011).There was no proved infection in ceftriaxone group.The mode of infection in ciprofloxacin group included bacteremia (n = 2, 16.7%), spontaneous bacterial peritonitis (n = 1, 8.3%) and urinary tract infection (n = 2, 16.7%).The isolated organisms were gram-positive cocci in 3 patients and gram-negative bacilli in 2 patients in ciprofloxacin group.Serum endotoxin level and intestinal permeability were more increased in bacterial infection group than non-infection group (23.69±36.34EU/mL vs. 0.15±0.15EU/mL and 1.41±1.23%vs. 0.58±0.92%).But, there were no statistically significant differences between two groups.Conclusions: The prevalence of bacterial infection is significantly lower in intravenous ceftriaxone group than oral ciprofloxacin group in advanced cirrhosis with gastrointestinal hemorrhage.Thus we would expect the therapeutic efficacy for prophylaxis of bacterial infection.

Wichtige Alltagsbehinderungen bei MS beruhen nicht nur auf körperlichen Behinderungen, sondern auch auf abnormer Ermüdbarkeit und kognitiven Leistungseinbußen.

Aims: Porto-pulmonary hypertension (POPH) is defined by an elevated mean pulmonary artery pressure (MPAP) and pulmonary vascular resistance (PVR) with a normal pulmonary artery occlusion pressure (PAOP). Recently, the transpulmonary gradient TPG (=MPAP-PAOP) was proposed as a new diagnostic tool in a pre-transplant cohort of patients (Hepatology 2006;44:1502).