Effect of previous exposure to HBV on liver histology and treatment response in CHC patients

To analyze the influence of previous exposure to HBV on liver histology and treatment outcomes in chronic hepatitis C [CHC] patients. Case control study. Rawalian Liver Clinic, Department of Medicine, Holy Family Hospital, Rawalpindi, from January 2011 to December 2012. Medical records of CHC patients attending the Rawalian Liver Clinic were retrospectively analyzed. Virological and treatment responses along with histological changes were compared between cases [anti-HBc positive] and controls [anti-HBc negative]. Significance was determined through chi-square test at p < 0.05. Among the 592 CHC patients, 254 [42.9%] had serological evidence of a positive anti-HBc [cases] and 338 [57.1%], patients had negative anti-HBc [controls]. No significant difference was found between ETR, SVR and treatment responses [n=220] between the two groups. Out of 65 patients whose liver biopsy data was available, cases were more likely to respond in the absence of fibrosis [63.2%, [n=24] vs. 36.8%, [n=14], p=0.001]. The controls responded more in the presence of fibrosis [100% [n=9] vs. 0, p=0.001]. There was no significant effect of anti-HBc positivity on grades of inflammation and consequent treatment response [p=0.14]. There are a significant number of CHC patients with markers of previous HBV infection in Pakistani population. Previous HBV [anti-HBc positive] does not seem to have an adverse effect on liver histology and treatment responses in HBV infection

Safety of non-anaesthesiologist-administered propofol sedation in ERCP

Propofol is increasingly being used for sedation purposes during endoscopic retrograde cholangiopancreatography [ERCP]. This study aimed to evaluate the safety of nonanaesthesiologist administration of propofol [NAAP] during therapeutic ERCP. Patients, who underwent ERCP at Centre for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi, were included in the study. Propofol sedation was administered by a physician who was a non-anaesthesiologist certified in basic and advanced cardiac life support. The total study duration was 6 months. The primary outcome variable was the frequency of any sedation-related complication. A total of 156 patients [41% males and 59% females] were enrolled in the study. The mean propofol dose used during the procedure was 201 +/- 132 mg. The mean propofol dose, when adjusted to weight and duration of procedure, was 0.05 +/- 0.04 mg kg[-1] min[-1]. According to the American Society of Anesthesiologists [ASA] classification. 136 [87%] patients were placed in ASA class I and II and 20 [13%] patients were of ASA class III. Only two patients developed sedation-related complication: one minor requiring bag-mask ventilation and other major requiring mechanical ventilation via endotracheal intubation. Both were managed by the trained non-anaesthesiologist and gastroenterologist at the pIace of procedure. No patients required cardiopulmonary resuscitation and admission to the intensive care unit. There were no sedation-related deaths. NAAP sedation can be considered safe for low-risk patients [ASA class I and II] undergoing ERCP. The presence of a trained anaesthetist is advisable in high-risk patients [ASA class III and higher] with significant co-morbidities

Incremental diagnostic value and impact on patient management of somatostatin receptor scintigraphy with indium-111-pentetreotide in gastroenteropancreatic neuroendocrine tumors

To evaluate the efficacy of somatostatin analog scintigraphy with indium-111-pentetreotide and its overall impact on management in patients with gastroenteropancreatic neuroendocrine tumors [GEP-NET]. Twenty-two consecutive patients with a proven or clinically suspected GEP-NET with or without proven metastases were imaged at 24 and 48 h after injection of [111] In-pentetreotide. The scintigraphic findings were compared with results from conventional imaging methods. The final diagnosis was based on histopathological and surgical findings and complementary radiology. Somatostatin receptor-positive lesions were found in 20 of the patients, whereas conventional methods were positive in 18 patients. Additionally, 13 new tumor sites were discovered by somatostatin receptor scintigraphy in 5 patients [liver: 6; chest: 2; bone: 1; abdomen: 4]. The surgical therapeutic strategy was changed in 7 patients [32%]. Our data reinforced that scintigraphy with [111]In-pentetreotide represents the imaging modality of choice in the initial evaluation of GEP-NET. It is highly accurate and can identify clinically unsuspected lesions and optimize the overall staging. It also guides optimal therapy choice and most importantly identifies patients with inoperable or metastatic disease who might be candidates for high-dose targeted therapy

Minimally invasive radionuclide-guided parathyroidectomy using [99m] Tc-Sestamibi in patients with primary hyperparathyroidism: a single-instituion experience

To evaluate the efficacy and usefulness of [99m]Tc- sestambi sccintigraphy and gamma probe localization of parathyroid glands in patients with primary hyperparathyroidism and establish radio-guided minimally invasive parathyroidectomy at Hussain Makki Al Jumma Center for Specialized Surgery, Kuwait. Twelve patients with primary hyperparathyroidism [mean age: 48 +/- 14 years; median age: 46 years; age range-29-68 years] were evaluated. The diagnosis of hyperparathyroidism was established by elevated serum calcium and parathyroid hormone levels. All patients had a well-defined parathyroid lesion on previous standard [99m]Tc-sestambi scintigraphy with or without ultrasound study. All had a normal thyroid gland, no history of familial hyperparathyroidism or multiple endocrine neoplasia nor any history of previous neck irradiation. On the day of surgery, patients were injected with 740 MBq [20mCi] of [99m]Tc-sestamibi followed by a half-hour-delayed single standard pinhole view of the neck. A skin marker was placed on the basis of maximum count intensity during gamma probe localization. Patients were then sent for radio-guided minimally invasive parathyroidectomy. The preoperative localization of the affected gland was successful in all cases using a gamma probe and [99m]Tc-sestamibi scintigraphy. The pathological parathyroid tissue was localized and successfully removed with the gamma probe. The histopathological diagnosis was parathyroid adenoma in 11 cases and hyperplasia in the remaining one. All patients remained disease and symptom free at 12-month follow-up. Our initial experience with intraoperative use of a gamma probe to carry out minimally invasive parathyroidectomy was a useful, easy and safe procedure for treating patients with primary hyperparathyroidism

Prediction of cardiac events in patients having left bundle-branch block with/without chest pain using dipyridamole technetium-99m-sestamibi myocardial perfusion imaging

To determine the prognostic value of myocardial perfusion scintigraphy with dipyridamole stress in patients with preexisting left bundle-branch block [LBBB] with or without chest pain. Seventy-six patients, mean age 53 +/- 10 years, with preexisting LBBB underwent technetium-99m-sestamibi perfusion imaging with dipyridamole infusion protocol [0.56 mg/kg]. Stress and rest single photon emission computed tomography [SPECT] images were interpreted by consensus of 2 experienced nuclear medicine physicians and classified as low-risk scans [normal myocardial perfusion scan, small reversible/small fixed defect] and high-risk scans [large, severe, fixed or reversible defect and dilated left ventricle cavity]. The patients were followed up for 24 +/- 8 months and occurrences of hard cardiac events [infarction or cardiac death] were noted. Of the 76 patients, 52 [68%] had low-risk scans and the remaining 24 [32%] had high-risk scans. In the low-risk group, 1 [1.9%] cardiac death and 2 [3.8%] cases of nonfatal myocardial infarction occurred, while in the high-risk group, 5 [20.8%] suffered cardiac death, and 3 [12.5%] nonfatal myocardial infarction. Overall survival rate was 98.1% in the low-risk group compared with 79.2% in the high-risk group with a significant difference of p = 0.034. Negative predictive value of normal myocardial perfusion scintigraphy for the occurrence of death was 100%. No significant difference in survival rate among patients with or without chest pain [p = 0.31] was observed. Myocardial perfusion imaging with dipyridamole provided important prognostic information in patients with LBBB; it was useful in stratifying the patients according to cardiovascular morbidity and mortality, and would thus allow the clinician to provide early treatment especially in the high-risk category