Echoguided pair technique in diagnosis and treatment of abdominal hydatid cystic disease in Egyptian patients: clnical and ultrasonographic follow up

The introduction of the percutaneous puncture, aspiration, injection of scolecidal agent and reaspiration [PAIR] technique is gaining an increasing acceptance in diagnosis and treatment of abdominal cystic hydatid disease [CHD]. Thirty-three patients [12 male and 21 female with age between 15 and 70 years] had 46 cysts in liver, spleen and kidneys [75.7%, 18.2% and 6.1% respectively]. Puncture, aspiration, injection of 95% sterile alcohol for 20 minutes and reaspitation [PAIR] was used for treatment of hydatid cysts of different types and sizes. Follow up both clinically and ultrasonographically was done over a period of 2 years. The commonest ultrasound picture was type la [overall echofree] in 80.4%, commonly in the liver [75.7%] mainly in the right lobe [88%]. Improvement of symptoms had occurred its 85% within 3 weeks. As regards ultrasound follow up of 41 non-complicated cysts within the 1[st] six months, was disappearance of 5 cysts, 34 reduced in size and 36 showed different grades of solidification. After 1.5 year 10 more cysts disappeared while the pseudotumour appearance was shown in remaining 26 cysts. Ultrasound follow up of the 5 infected cysts revealed complete cure within a period of 8-16 weeks in 4 of them. The last patient discontinued drainage therapy and was referred to surgery. This makes ultrasound cure reaching 97%. Minor complications were skin reaction only in 2 patients [6%]. No fatal anaphylaxis cyst recurrence or rupture into the peritoneal cavity or bleeding from renal or splenic puncturing. PAIR technique under ultrasonographic guidance is the first choice method for treatment of abdominal CHD especially in the developing countries and inoperable hydatid cysts

Alterations in colonic mucosal lesions in patients with portal hypertension

Portal hypertensive colopathy [PHC] is a clinical entity in liver cirrhosis. The frequency and profile of colonic mucosal lesions of this entity are not well studied. The aim of this study is to evaluate the prevalence of colonic mucosal changes in patients with liver cirrhosis and their clinical significance. Forty patients with post-viral liver cirrhosis and portal hypertension [PHT] underwent upper gastrointestinal endoscopy as well as a full length colonoscopy to detect changes in colonic mucosa. PHC was diagnosed endoscopically by the presence of vascular ectasia, diffuse hyperaemic mucosa and rectal varices. Biopsies were obtained from the recto-sigmoid area as well as from any abnormal mucosal lesions apart from angiodysplastic areas. Diffuse hyperaemia, angiodysplasia and rectal varices were found in 40%, 32.5% and 17.5% of patients while haemorrhoids in 42.5%, respectively. The prevalence of PHC increased with worsening Child-Pugh class, the mere presence of oesophageal varices while platelet count was significantly associated with angiodysplastic lesions only. None of other upper endoscopic features of PHT was significantly related to PHC. Moreover, history of lower gastrointestinal [GI] bleeding was significantly associated with the presence of rectal varices and haemorrhoids. Colonoscopic features of PHC were significantly associated with the histopathological diagnosis revealing 79% sensitivity and 66.6% specificity. Conclusion: PHC is a frequent finding in patients with PHT. Colonoscopic features suggestive of PHC were in concordance with the histopathological evidence. Although the presence of haemorrhoids is not a feature of colopathy, yet it should be considered together with anorectal varices as a cause of lower GI bleeding

Study of the enhancing effect of sodium chloride injection on radiofrequency ablation of hepatocellular carcinoma

One of the potential strategies to increase the efficacy of RFA is to modulate the biologic environment of the treated tissues. Several investigators have studied increasing RFA heating by combining intra-tumoral injections of different concentrations of sodium chloride with RFA. The aim of this study is to assess the enhancing effect of normal saline [NS] on radiofrequency ablation [RFA] of hepatocellular carcinoma [HCC] using a cool-tip needle. This study included 40 patients with HCC [proved by histopathology or combined spiral CT and elevated alpha-fetoprotein]. They were randomly divided into two groups [20 patients in each group]. The first group was treated with RFA preceded by intra-tumoral normal saline injection [RFA + S]; the second group was treated with RFA only [RFA]. The procedure was successful in all patients [100%] of the RFA + S group and in 11 [55%] of the RFA group [as proved by spiral CT or pathology]. This difference between the two procedures was statistically highly significant [P = <0.01]. No major complications occurred in either group. Combined RFA and normal saline is more effective than RFA alone. Considering the reduced cost and wide availability of isotonic saline together with the easy performance of the intra-tumoral injection, the dramatic improvement in therapeutic effect of RFA to 100% could be a breakthrough in future strategies to modernize the RFA technique