Efficacy of octreotide and sclerotherapy in the treatment of acute variceal bleeding in cirrhotic patients. A prospective, multicentric, and randomized clinical trial.

BACKGROUND: Sclerotherapy is the most widely used method for treatment of acute variceal bleeding. Previous reports have suggested that octreotide infusion is as effective as sclerotherapy. Our aim was to investigate the efficacy and safety of octreotide in comparison with sclerotherapy in controlling variceal bleeding. METHODS: Seventy-six cirrhotic patients were randomized to receive either sclerotherapy (n = 37) or octreotide (n = 39) infusion of 50 microg/h intravenously for 48 h after a bolus of 100 microg, followed by subcutaneous injection of 100 microg/8 h for an additional 72 h. RESULTS: The two groups were similar in base-line data. A similar initial control of bleeding was obtained in 94.6% for sclerotherapy and 84.6% for octreotide (NS). No difference was observed between sclerotherapy and octreotide in rebleeding (23% versus 33%) and treatment failure (22% versus 36%, respectively). Furthermore, the overall success of treatment was 78% for sclerotherapy and 64% for octreotide. No significant difference in mortality was observed between treatments (eight patients for octreotide and three patients for sclerotherapy, NS). CONCLUSIONS: These results show that both treatments present a very high and similar initial and final control of bleeding. However, there is a trend that could be clinically important towards better results in the patients treated with sclerotherapy.

[Inversion of the ventricles and major vessels]. / Inversiia zheludochkov i magistral'nykh sosudov.

The authors carried out a detailed anatomic examination of hearts from 17 fatal cases in which the diagnosis of corrected transposition of the aorta and pulmonary artery had been made by the clinical data. Corrected transposition was found in 13 preparations and rare complicated heart defects in the other 4. The paper describes at length the anatomy of the ventricles, great vessels and coronary arteries of the heart in corrected transposition as well as the anatomy of the accompanying defects. The analysis of the observations shows the defect of the interventricular septum, insufficiency of the arterial atrioventricular valve, and pulmonary artery stenosis to be the most frequent accompanying heart defects in corrected transposition of the aorta and pulmonary artery. Not infrequently, several accompanying defects were combined in one heart. The authors confirm the conclusion of other investigators concerning the necessity of segmentary approach to the study of the heart structure in conotruncus abnormalities.

[Clinical course and diagnosis of congenital heart defects]. / Klinika i diagnostika neopredelenno-sformirovannogo serdtsa.

An indefinitely formed heart is a compound lesion of the cardiovascular system in which an anatomical examination of the atria does not permit any decisive interpretation of the formation of the heart. The disease can be subdivided into two pathological syndromes. The first syndrome includes a partially patent atrioventricular canal with a joint atrium, an absence of the hepatic segment of the inferior vena cava, a partally anomalous drainage of the pulmonary veins, bilobular lungs, abdominal heterotaxy and polysplenism. The second syndrome is characterized by an open atrioventricular canal with a joint atrium or a cor biloculare, an abberant superior vena cava, or varilateral position of the superior and inferior venae cavae, a completely anomalous drainage of the pulmonary veins, transposition of the major vessels with a stenosis or atresia of the pulmonary artery, trilobular lungs, abdominal heterotaxy and asplenism. The leading role in the diagnosis of the pathology belongs to heart catheterization and angiocardiography.