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Intramuscular (i.m.) and Intradermal (i.d.) vaccination against hepatitis B (HB) are efficient in hemodialysis patients. We retrospectively analysed the response of 32 patients during 48 consecutive months and compared the results of the two vaccination routes using the recombinant vaccine (Engerix, SKB). Thirteen patients were vaccinated with 5 mcg i.d. every 2 weeks (total 8 doses), plus an i.m. dose on month (M) 12 (group A). Nineteen patients (group B) were vaccinated with 4 i.m. doses of 20 mcg each, on months M0, 1, 2 and 12. HB antibodies were measured on M5, M11, M13, M24, M36 and M48. An additional 20 mcg i.m. dose was given with titers below 10 mIU/ml. Seroconversion, seroprotection and antibody levels were equivalent in both groups up to M13; with the exception of seroconversion rates, a significantly different response was observed afterwards (A/B, in mIU/ml): M5: 399 +/- 107 vs 342 +/- 69, M13: 536 +/- 118 vs 673 +/- 61, M24: 278 +/- 94 vs 595 +/- 81, P=0.02, and M48: 68 +/- 29 vs 565 +/- 92, P=0.003. Early HB(S)AB levels did not correlate with those found four years later in both groups. An additional booster dose was given 8 times in 4 group A patients (1-3 doses/patient) and 3 times in 1 group B patient. Immune response to HB vaccine in hemodialysis patients is initially equivalent by both immunization routes. Late antibody titers were found significantly lower in i.d. immunization with more frequent booster doses needed.

Incomplete protection and response variability have been reported in chronic renal failure (CRF) and hemodialysis (HD) patients vaccinated against hepatitis B with the recombinant vaccine (rHBV). We vaccinated 12 consecutive patients (7 CRF and 5 HD), 7 males and 5 females, 61 years old (range 22-82); HD patients were on treatment from 1 to 12 months. CRF patients had a residual renal function (creatinine clearance) of 11 +/- 3 mL/min. Six patients had been already vaccinated unsuccessfully, as defined by the absence of detectable specific antibody S (Abs) 1 month after the completion of vaccination by the classical intramuscular method, with a median of 7 (range 3-18) doses of 20 micrograms. rHBV was given intradermally (i.d.) at the dose of 5 micrograms every fortnight up to 8 doses or until titers of Abs rose above 1000 mIU/mL. Levels above 10 mIU/mL were considered as protective. Abs titers were monitored during the whole vaccination period every 15 days and at the 1st, 3rd, and 6th month after its completion. Median number of i.d. doses given was 7 (range 4-8). Antibody titers rose gradually; surface antibodies (AbS) were detected as early as the end of the first month (2nd dose). Age and sex had no influence on the immune response, its duration, or antibody titers. i.d. administration of rHBV in repeated small injections was found to be absolutely effective, in both CRF and HD patients. AbS titers after multiple i.d. vaccination rose gradually in CRF and HD patients, and were protective for at least 6 months after the last injected dose. Protective levels were achieved even in patients not responding to multiple-double quantity intramuscular (i.m.) doses. Patients with stronger initial response to the vaccine (after the 4th dose) gave significantly higher AbS titers (at least in 50% of the follow-up measurements), although they received fewer injections and smaller total dose of vaccine.

Carcinoma of the prostate, above all when accompanied by bone metastases, may be associated with a disseminated intravascular coagulation syndrome. The problem was to determine whether even in the absence of metastases the coagulation state of prostatic carcinoma patients predisposes them to disseminated intravascular coagulation. The authors compared coagulation equilibrium in 13 patients with a prostatic adenoma and 21 with carcinoma of the prostate free of metastases or infection. Fibrin breakdown product levels were abnormally high in 85.7 % of the carcinoma patients (as against 46.2 % of the adenoma sufferers). Clotting factor XIII was decreased in 70 % of carcinoma patients (as against 48.5 % of those with an adenoma). One prostatic carcinoma patient in four shows evidence of latent intravascular coagulation even in the absence of bone metastases. This prevalence justifies thorough coagulation studies in all patients with carcinoma of the prostate.