Comparison Between Two Volumes of 70% Alcohol in Single Injection Ultrasound-Guided Celiac Plexus Neurolysis: A Randomized Controlled Trial.

BACKGROUND: Pain due to inoperable upper abdominal malignancies is a challenging condition that needs a multimodal analgesic regimen to be managed properly. Celiac plexus alcohol neurolysis was proved to be effective in relieving such type of pain; however, there is no consistent data about the optimal volume to be used to maintain the balance between the neurolytic effect and the destructive effect of alcohol. OBJECTIVES: We aim to compare the analgesic effect of 2 different volumes of alcohol to improve the outcome of interventional management. STUDY DESIGN: This was a randomized controlled double-blinded interventional clinical trial. SETTING: Single university hospital. METHODS: Thirty-two patients who suffered from abdominal pain due to unresectable abdominal malignancies were randomly allocated to receive in a single injection ultrasound-guided celiac plexus neurolysis (CPN) with injection of either 20 mL 70% alcohol (CPN20 group) or 40 mL 70% alcohol (CPN40 group). The primary outcome was the post-procedure pain score, while the secondary outcomes included the post-procedure total daily opioid consumption and quality of life (QOL). RESULTS: There was no statistically significant difference between both groups regarding visual analog scale (VAS) scores at all time points (P-value > 0.05); however, comparisons in each group revealed significantly reduced VAS scores at all time points following the intervention when compared to the baseline. Daily morphine equivalent consumption doses showed statistically significant differences between the baseline and each time point in both groups (P value < 0.05), with no significant difference between both groups at each time point (P value > 0.05). There was no statistically significant difference between the study groups regarding all domains in quality of life assessment at all time points (P value > 0.05). The scores of most time points in all domains were different significantly when compared to the baseline readings in both groups, with a tendency to decline over time in both groups approaching the baseline values. LIMITATIONS: This was a single-center study with a relatively small sample size. Further prospective, multicenter, randomized, and controlled studies with a larger sample size are required to confirm the effects in this study. CONCLUSIONS: During ultrasound-guided CPN for patients with inoperable upper abdominal cancers who failed medical management, a volume of 20 mL is as effective as 40 mL of 70% alcohol regarding pain control, opioid consumption, quality of life, and procedure-related complications.

Large gastrointestinal stromal tumor size does not imply early recurrence.

A 28-year-old female presented with a huge intra-abdominal mass. Initially a mesenteric mass was diagnosed, but her tumor was found to be a gastrointestinal stromal tumor (GIST). Laparotomy was performed. The mass was resected en bloc with clear surgical margins in January 2007. It was found to be 20 × 18 × 16 cm. In order to remove the tumor, the left half of transverse colon with its mesocolon, spleen, body and tail of pancreas, and a part of the small intestine had to be removed. The mass was tightly attached to these viscera. The tumor was surgically removed three years ago. The pathology report of the case presented places the tumor in the high-risk category. The tumor had a relatively high mitotic index. It was positive for CD117 and CD34 stains and also positive for smooth muscle actin. Although the patient did not receive adjuvant chemotherapy, no signs of local recurrence or distant metastasis could be recognized on follow up. Surgery remains the standard initial management for all localized GISTs. The tumor should be removed en bloc, with clear surgical margin. The case presented indicates no association of tumor size with early local recurrence of the tumor or early distant metastasis.

Detection of E. histolytica, G. lamblia and Cryptosporidium copro-antigens in stool samples.

A double antibody sandwich ELISA technique, using a chromatography purified antisera against E. histolytica, G. lamblia and Cryptosporidium antigens, was applied to detect copro-antigens of the corrosponding parasites in 90 patients. All positive cases were diagnosed by parasitological examination and proved to have the infection solely. Beside the 90 positive cases, 40 age-matched controls were included in the study, of which 20 individuals were infected with other parasites but not Cryptosporidium, E. histolytica or G. lamblia (acted as an infected control group) and the other 20 individuals with no intestinal parasites (normal control group). The assay could detect 100% of those infected with both of G. lamblia and E. histolytica and 96.6% (29/30) of patients with Cryptosporidium infection. False positive reactions were detected in 3 cases using G. lamblia antisera (92.5%), 5 cases using E. histolytica antisera (87.5%) and 2 cases using Cryptosporidium antisera (95%). A direct increase in the mean antigen level was observed with the increasing intensity of infection in the 3 parasites, so higher mean O.D. readings was observed in heavily infected cases than moderately infected cases than lighter intensity of infection. Only those in elder age group (> 20 years) infected with E. histolytica were found to have statistically higher O.D. readings of the antigen than middle age group (10-20 years). On the other hand, no statistically significant difference was observed between different age groups and antigen level in cases with either G. lamblia or Cryptosporidium.