ABSTRACT
Background and study aims: Splenectomy has been associated with high perioperative morbidity and mortality. Partial splenic artery embolisation [PSE] was found to be an effective and safer method but with numerous complications. Local thermal ablative techniques such as microwave ablation [MWA] have been tried and were found to be safe and effective alternatives. This randomised controlled study aimed to compare the efficacy and safety of MWA versus PSE in the treatment of hypersplenism in patients with post-hepatitis C cirrhosis
Patients and methods: In total, 40 patients with post-hepatitis C cirrhosis complicated with hypersplenism were randomised into two groups: Group I: 20 patients treated with percutaneous MWA of splenic parenchyma under ultrasound guidance and Group II: 20 patients treated with PSE using Embosphere
Results: There was a significant increase in haemoglobin levels in group I compared with group II after 3 months of follow-up. However, White blood cell [WBC] count and platelets significantly increased more in group II than in group I after 1 month. Postprocedure significant hyperbilirubinaemia, hypoalbuminaemia, decreased prothrombin concentration, and increased creatinine levels were encountered in group II only. There was a significant increase in postoperative complications in group II compared to group I, and a single case of mortality was reported in group II
Conclusion: MWA and PSE were comparably effective; however, MWA was safer than PSE, which caused serious adverse events and mortality. MWA appears to be a good alternative for the treatment of hypersplenism in patients with cirrhosis and portal hypertension
ABSTRACT
We report a series of cutaneous Herpes Zoster [HZ] reactivation cases in patients with hepatitis C virus [HCV] infection treated with directly acting antiviral [DAA] agents. Five cases were detected among 2133 treated patients with DAAs at one of the specialized viral hepatitis treatment centers in Egypt. A control group including 2300 age and sex matched HCV patients who were previously treated with pegylated interferon and ribavirin did not show any HZ reactivation reports while on treatment. None of cases had an evidence of immunosuppression or a risk factor for HZ reactivation. The DAAs used regimens were sofosbuvir/daclatasvir in 4 cases and sofosbuvir/simeprevir in one case. HCV clearance with antiviral therapy may bring immune changes causing reactivation of other latent viral infections like HZ. A high index of clinical suspicion may be needed to guarantee early and prompt management of such cases