value of Hetastarch in prophylaxis against renal impairment in cirrhotic patients with spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis [SBP] is an ominous complication of the late stage liver disease. Renal impairment in the course of SBP is a frequent event and constitutes the most important predictor of hospital mortality in these patients. Administration of intravenous albumin was applied for prevention of SBP related renal impairment and it reduced the incidence of renal impairment and mortality in comparison with treatment with antibiotic alone. Because albumin is expensive and not available in some settings, we worked to assess the possible use of Hetastarch and assess its beneficial effects in prevention of SBP related renal impairment. The present study was conducted on 60 patients with liver cirrhosis, ascites and SBP. The patients were divided into two groups: Group [1]: 30 subjects who received empirical antibiotic plus plasma expander for treatment of SBP and Group [2]: 30 subjects who received empirical antibiotic alone. The plasma expander chosen was Hetastarch [the colloidal solution hydroxyethyl starch [Haes-steril] in a dose of 500 cc every 8 hours/5 days [20 ml/kg B. wt/day] due to its relative less side effects on coagulation process. It was found that the administration of Hetastarch as a artificial plasma expander decreased renal impairment in patients with liver cirrhosis and spontaneous bacterial peritonitis. The incidence of renal impairment was significantly lower among patients treated with antibiotic therapy plus plasma expander [13.3%] than those treated with antibiotic alone [36.6%]. Patients received Hetastarch showed maintenance of renal function allover the follow up period, higher urine output, better renal profile than other group not treated by Hetastarch. We concluded that treatment with Hetastarch was safe and effective and it can be considered as an alternative to albumin in prophylaxis against renal impairment in cirrhotic patients with SBP

Treatment of hepatocellular carcinoma in cirrhotic patients: a prospective randomized study comparing radiofrequency and ethanol injection

Although surgery remains as a gold standard line for management of hepatocellular carcinoma [HCC], many cases are not candidates for surgery due to underlying chronic liver disease and limited functional reserve even with recent advances in the field of surgery. At the same time several local ablative techniques have emerged and proved to be minimally invasive and effective measures for in situ control of HCC, of these techniques, radiofrequency ablation [RFA], and percutaneous ethanol injection [PEI]. The aim of the current study was to evaluate the safety and efficacy of RFA and ethanol injection for the treatment of HCC, to reach a protocol for proper management of unresectable HCC and, also to assess the quality of life before and after each technique. In the current study we had two groups of patients with HCC on top of cirrhosis due to hepatitis C virus [HCV] infection, one of them was subjected to RFA [G 1] and the other [G2] was subjected to PEI as therapeutic modalities for their HCC. As regards GI, it included 30 patients with 36 HCC lesions with a mean size of 3.02 cm which were treated by percutaneous US guided RFA using cooled-tip electrodes with a mean of 1-2 sessions of RFA. Studied patients were followed over variable periods that ranged between 6-18 months with a mean of 11.6 months. The responses to therapy were as follows: Complete ablation in 32 out of 36 lesions [88.8%], partial response in 3 out of 36 lesions [8.3%], recurrence in 3 [8.3%] lesions, and newly developed lesions in 7 cases. G2 included 20 patients with 26 HCC lesions with a mean size of 3cm for which we used PEI modality, we found that 21 out of 26 lesions [80.7%] had complete response, 4 out of 26[15.3%] had partial response and one [3.8%] showed local recurrence, and newly developed lesions were seen in 5 cases. The period of follow up ranged from 4-12 months with a mean of 10 months. As regards survival, one year survival rate was 75% in GI and 80% in G2. We concluded that, both RFA and PEI are safe and effective procedures and result in significant improvement in quality of life in patients with unresectable HCC. RFA showed higher rate of complete necrosis and requires fewer sessions than PET in the management of HCC

Comparative study between endoscopic band ligation, alcohol injection and cyanoacrylate injection in management of gastric varices

Haemorrhage from gastric varices [GV] is a serious complication of portal hypertension. The role of endoscopy in the management of gastric varices is still controversial, but the efficacy in management of bleeding oesophageal varices has been greatly enhanced, so, rebleeding rate has been reduced by injection sclerotherapy or band ligation. On the other hand, the management of gastric varices is still a great challenge for endoscopists as traditional methods as vasoconstrictors and balloon tamponade don't effectively reduce the rebleeding rate. The aim of our work was to compare three different endoscopic methods in the management of type I and II gastric varices: [I] gastric variceal obturation using cyanoacrylate, [II] gastric variceal sclerotherapy using absolute alcohol and [III] gastric variceal ligation by rubber [O] bands. The comparison regards the technical ease, efficacy, complications and number of sessions needed to eradicate varices. To fulfill this aim we studied 60 patients with chronic liver disease and gastric varices presented to the central endoscopy unit Ain Shams University Hospital. The patients were categorized into [3] groups: Group I included 20 patients who underwent GV obturation using cyanoacrylate, group II included 20 patients who underwent GV sclerotherapy using alcohol injection, and group III included 20 patients who underwent GV band ligation. All patients were age and sex matched. We excluded patients with type III GV, hepatic encephalopathy, hepatocellular carcinoma and prior history of sclerotherapy, band ligation or shunt operation. Our results showed that, cyanoacrylate obturation of gastric varices was more effective in controlling gastric variceal bleeding than other methods with low number of sessions and low rebleeding rate than G.V. Ligation or alcohol injection. So we conclude that gastric variceal obturation by cyanoacrylate proved more effective and safer than gastric variceal ligation or injection sclerotherapy using absolute alcohol in the management of type I and II gastric varices

Cystopericystectomy for treatment of hydatid disease of the liver: a prospective randomized study

Surgical intervention remains the principal form of definitive treatment of liver echinococcosis. The aim of this report is to evaluate the technique of cystopericystectomy for treatment of liver hydatid disease, comparing the results of this technique with the traditional surgical technique of cyst evacuation. Method: Twenty three patients with hydatid disease of the liver were randomized into two groups. Twelve cases were managed by cystopericystectomy and compared with 11 cases managed by the more conservative technique of cyst evacuation. Thoracic x-ray, abdominal ultrasound and computed tomography had been performed previously. The following aspects were considered as selection criteria: Cyst located in segments III, IV, V, VI and VIII; and no evidence of infection or calcification. Cystopericystecomy was total closed cystopericystectomy [n=6], total open cystopericystectomy[n=4], and subtotal cystopericystectomy[n=2]. All patients were treated with oral albemdazole for two months after surgery. The mean operation time, blood transfusion, hospital stay and any evidence of hydatid recurrence we measured and statistical analysis was done. Result: Surgery was performed on 23 patients with liver hydatid disease [12 women and 11 men] with a mean age of 44.9 years [range, 22-83 years], the mean diameter of liver cyst was 7.6 cm [range, 5-12 cm]. The mean [s.d] operration time was 186.3 +/- 35.2 minutes in the group of cystopericystectomy, and it was 145.4 +/- 24.6 minutes in the traditional surgical technique of cyst evacuation, and the difference was statistically significant [P<0.05]. Blood transfusion was required in 5 patients [41.6%] in the group of cystopericystectomy, and in 2 patients [18.2%] in the traditional technique of cyst evacuation, and the difference was not statistically significant [P>0.05]. Hospital stay was 11.3 +/- 4.1 days in cystopericystectomy group and 12.1 +/- 4.6 days in the traditional techique of cyst evacuation, with no difference between the two groups. During a mean follow - up period of 18 months [range, 12-30 months], no mortality was verified. The incidence of postoperative complications was 8.3% in the group randomized to cystopericystectomy and it was 18.2% in the group randomized to cyst evacuatin. Recurrence of hydatid disease was observed in one patient [9.1%] in the group treated by cyst evacuation, but no recurrence was observed in cystopericystectomy. The technique of cystopericystectomy is a valuable alternative to the more conservative technique of cyst evacuation in selective cases. The results of cystopericystectomy are comparable with the results of conservative surgical technique, with a lower incidence of morbidity and recurrence of hydatid disease in cystopericystectomy when compared with the traditional more conservative surgical technique of cyst evacuation