Dieulafoy's lesion: new diagnosis usinghigh? definition endoscopy and treatment withisoamyl 2 cyanoacrylate [Amcrylate]

Dieulafoy's lesion [DL] is a rare but important cause of gastrointestinal [GI] bleeding, accountingfor up to 6% of the cases of nonvariceal bleeding in the upper GI tract and 1-2% of all GIhemorrhages. Mortality rates are similar to those of other causes for GI bleeding. Following ourstrategy, an expert endoscopist with a skilled assistant should have a high rate of successful DL diagnosis when an obscured GI lesion is suspected. In our seven case study, we thinkit was feasible to use high?definition Fujinon intelligent chromoendoscopy to diagnose DL. Isoamyl 2 cyanoacrylate [Amcrylate] was effective and safe for treating DL as well as wereother strategies, including ethanolamine oleate, band ligation, and nebutyle 2 cyanoacrylate. Surgical wedge resection of the lesion should be considered as a therapeutic option if endoscopic therapy fails

Noninvasive prediction of HCV 4 SVR by 2D US: a randomizedstudy using data mining algorithm

Objective and aim :Hepatitis C virus [HCV] can cause both acute and chronic hepatitis. Antiviral therapy is thecornerstone for the treatment of chronic HCV infection once diagnosis is confirmed by PCR. Thegoal of antiviral therapy is to eradicate HCV RNA or attain sustained virological response [SVR]. In many countries worldwide, including Egypt, HCV infection is treated with a combination of pegylated interferon [and ribavirin [RBV]. Liver fibrosis/cirrhosis stage influences theresponse to pegylated interferon [and RBV. Even with new oral the rapies such as Sovaldimany patients have to continue to be on combination regimens of interferon/RBV or RBV alone. In the current study, we aimed to use data mining analysis to determine sonographic picturesthat can successfully predict SVR in HCV-4 patients before the antiviral therapy

Methods: Eighty-two patients were enrolled in this study and they underwent two-dimensional ultrasound examination before the antiviral therapy. The sonographic data obtained were analyzed with Rapidminer version 4.6 to create a decision tree algorithm for the prediction of SVR

Results: The absence of significant liver fibrosis was a predictive parameter of SVR mainly in those patients without a sonographic picture of cirrhosis. The resulting tree yielded an accuracy, sensitivity, and specificity of 85.82 +/- 10.79, 68.75, and 96.00%, respectively, upon 10-foldcross-validation

Conclusion: In the current study we used decision tree algorithm, one of the most important computational methods and tools for data analysis and predictive modeling in applied medicine, to predict SVR in HCV-infected patients. Two-dimensional ultrasound can give predictive information regarding the treatment outcome before interferon therapy for HCV-4

Evaluating the effect of midodrine on renal resistance index in patients with liver cirrhosis and ascites

Background: Portal hypertension, which occurs as a consequence of liver cirrhosis, leads to splenic vasodilatation and alterations in the systemic circulation. Arterial vasodilatation in the splanchnic circulation appears to play a central role in hemodynamic changes and in the decline in renalfunction in cirrhosis. Peripheral vasodilatation, which occurs as a part of alterations in the systemic circulation, may decrease the renal blood flow and subsequently raise plasma renin activity. Midodrine is a agonist and acts as a peripheral vasoconstrictor; therefore, it may reduce plasma renin activity and improve renal function

Aim of the work: The aim of the study was to evaluate the relationship between renal resistive indices [RIs]in cirrhotic patients before and after oral administration of 7.5 mg midodrine three times dailyfor 3 days

Patients and methods:The study was conducted on 40 patients with liver cirrhosis and ascites and on 40 healthy controls from October 2014 to March 2015 at Al Azhar University Hospital, Assiut, where allpatients were subjected to history and clinical examination as well as to routine investigations such as total bilirubin, albumin, international normalized ratio, and serum creatinine. Patients underwent an abdominal ultrasound with duplex Doppler examination of the kidneys, and RIwas calculated before and 3 days after oral intake of midodrine

Results: Patients with liver cirrhosis and ascites had significantly higher RI in the right kidney[0.69 +/- 0.101 vs. 0.57 +/- 0.055, P < 0.001] and in the left kidney [0.69 +/- 0.097 vs. 0.59 +/- 0.047,P < 0.001] compared with healthy controls. After oral administration of midodrine for 3 days,RI showed significant improvement [RI = 0.928, P < 0.001] in the right kidney and in theleft kidney [R = 0.993, P < 0.001]. RI had significant positive correlation with Child-Pughscore [R = 0.75, P < 0.001, in the right kidney and R = 0.75, P < 0.001, in the left kidney] and significant positive correlation with Model for End Stage Liver Disease score [R = 0.536,P < 0.008, in the right kidney and R = 0.487, P < 0.005, in the left kidney]

Conclusion: Oral midodrine improved renal hemodynamics as assessed by RI in cirrhotic patients. RI is correlated with severity of liver disease as assessed by Child-Pugh and Model for End StageLiver Disease scores