BALLOON TAMPONADE TECHNIQUE AND EFFICACY IN VARICEAL HEMORRHAGE

Background: The option of using direct compression to arrest haemorrhage from an oesophageal varix was introduced by Westphal in 1930. Since then, different types of oesophageal and or gastric balloons have become available for use. The published data concerning the efficacy and complications of the balloon tamponade in the treatment of variceal haemorrhage is evaluated. Method-results: Balloon tamponade as a single therapy may control initial variceal haemorrhage in more than 80% of cases. However, haemostasis is usually transient and is associated with a high rate of complications. As regards the comparison of balloon tamponade with vasoactive drugs such as vasopressin alone or vasopressin + terlipressin or terlipressin + nitroglycerin, it appears that both regimens are comparable in respect to initial control of bleeding, rebleeding, mortality, and complications. There is also evidence suggesting that balloon tamponade is as equally effective as octreotide and somatostatin in the initial control of variceal haemorrhage, but early rebleeding and complications are significantly less with the administration of both drugs. Finally, it appears that balloon tamponade is inferior to endoscopic sclerotherapy in both the acute and the long-term control of variceal haemorrhage. Conclusions: Balloon tamponade should be reserved for those patients with variceal haemorrhage in whom bleeding continues despite conservative treatment, or as the first form of treatment only if sclerotherapy is not available

Tourniquet use in total knee arthroplasty and the risk of infection: a meta-analysis of randomised controlled trials

Abstract Purpose The intra-operative use of tourniquets during Total Knee Arthroplasty (TKA) is common practice. The advantages of tourniquet use include decreased operating time and the creation of a bloodless visualisation field. However, tourniquet use has recently been linked with increased post-operative pain, reduced range of motion, and slower functional recovery. Importantly, there is limited evidence of the effect of tourniquet use on infection risk. The purpose of this systematic review and meta-analysis is to fill this gap in the literature by synthesising data pertaining to the association between tourniquet use and infection risk in TKA. Methods A systematic literature search was performed on Pubmed, Embase, Cochrane and clinicaltrials.gov up to May 2021. Randomized control trials were included, comparing TKA outcomes with and without tourniquet use. The primary outcome was overall infection rate. Secondary outcomes included superficial and deep infection, skin necrosis, skin blistering, DVT rate, and transfusion rate. Results 14 RCTs with 1329 patients were included. The pooled incidence of infection in the tourniquet group (4.0%, 95% CI = 2.7–5.4) was significantly higher compared to the non-tourniquet group (2.0%, 95% CI = 1.1–3.1) with an OR of 1.9 (95% CI = 1.1–3.76, p = 0.03). The length of hospital stay, haemoglobin drop (0.33 95% CI =0.12–0.54), P = 0.002) and transfusion rates (OR of 2.7, 95%CI = 1.4–5.3, P = &lt; 0.01) were higher in the tourniquet group than the non-tourniquet group. The difference in the length of inhospital stay was 0.24 days favouring the non-tourniquet group (95% CI = 0.10–0.38, P = &lt; 0.01). The incidence of skin blistering (OR 2.6, 95% CI = 0.7–9.9, p = 0.17), skin necrosis (OR 3.0, 95% CI = 0.50–19.3, p = 0.25), and DVT rates (OR 1.5, 95% CI = 0.60–3.60, p = 0.36) did not differ between the two groups. Conclusion Quantitative synthesis of the data suggested tourniquet use was associated with an increased overall risk of infection, intraoperative blood loss, need for blood transfusion and longer hospital stay. Findings of this meta-analysis do not support the routine use of tourniquet in TKA and arthroplasty surgeons should consider any potential additional risks associated with its use. Level of evidence meta-analysis, Level II. </jats:sec

Endoscopic sclerotherapy versus variceal ligation in the long-term management of patients with cirrhosis after variceal bleeding - A prospective randomized study

Background/Aims: Long-term endoscopic injection sclerotherapy of oesophageal varices prevents rebleeding in patients with cirrhosis surviving an acute variceal bleeding episode, However, this treatment is associated with a substantial complication rate, Endoscopic band ligation is a newly developed technique in an attempt to provide a safer alternative, The aim of this study was to compare the efficacy and safety of injection sclerotherapy versus variceal ligation in the management of patients with cirrhosis after variceal haemorrhage. Methods: Seventy-seven patients with cirrhosis who proved to have oesophageal variceal bleeding were studied, After initial control of haemorrhage by sclerotherapy, 40 of the patients were randomly assigned to sclerotherapy and 37 to ligation, Both procedures were performed under midazolam sedation at intervals of 7-14 days until all varices in the distal oesophagus were eradicated or were too small to receive further treatment. Results: The eradication of varices required a lower mean number of sessions with ligation (3.7 +/- 1.9) than with sclerotherapy (5.8 +/- 2.7, p = 0.002). The mean duration of follow-up was similar in both groups (15.6 months +/- 7.3 and 15 +/- 7.4, respectively), The proportion of patients remaining free from recurrent bleeding against time was significantly higher in the ligation group as compared to the sclerotherapy group (chi(2) = 3.86, p = 0.05), Only 13 patients (35%) developed complications in the ligation group as compared to 24 (60%, p = 0.05) in the sclerotherapy group. The mortality rate was similar in both groups (20% and 21%, respectively). Conclusions: Variceal ligation is better than sclerotherapy in the long-term management of patients with cirrhosis after variceal haemorrhage which was initially controlled with sclerotherapy

Are Thyroid Hormone and Tumor Cell Proliferation in Human Breast Cancers Positive for HER2 Associated?

Objective. This study investigated whether thyroid hormone (TH) levels are correlated to cell proliferation (Ki67), in euthyroid breast cancer patients. Design and Methods. 86 newly diagnosed breast cancer patients with estrogen receptor (ER) positive tumors, who referred for surgery, were included in the study. Results. FT3, FT4, and TSH were within normal range. No correlation was seen between Ki67 and FT3 (r=-0.17, P=0.15), FT4 (r=-0.13, P=0.25), or TSH (r=-0.10, P=0.39) in all patients studied. However, subgroup analysis showed that, in HER2(+) patients, a negative correlation existed between FT3 levels and Ki67 (r=-0.60 and P=0.004) but not between Ki67 and FT4 (r=0.04 and P=0.85) or TSH (r=-0.23 and P=0.30). In HER2(-) patients, there was no significant correlation between Ki67 and FT3 (r=-0.06, P=0.67), FT4 (r=-0.15, P=0.26), or TSH (r=-0.09, P=0.49). Phospho-p44/total p44 ERK levels were found to be increased by 2-fold in HER2(+) versus HER2(-) tumors. No difference was detected in phospho-p42/total p42 ERK levels. Conclusions. TH profile is not altered in patients with newly diagnosed breast cancer. However, FT3 levels, even within normal range, are negatively correlated with cell proliferation in HER2(+) breast cancer tumors. This response may be due to the interaction between ERK and TH signaling. © 2015 Iordanis Mourouzis et al

Effects of endoscopic variceal treatment on oesophageal function: a prospective, randomized study

Aim Endoscopic methods are currently the most widely used techniques for the treatment of bleeding oesophageal varices (BOV). However, a number of complications may limit their usefulness. We conducted a prospective, randomized comparison of variceal ligation versus sclerotherapy in cirrhotics; after the control of variceal haemorrhage to study the relative short-term risks of these two procedures with respect to oesophageal motility and gastro-oesophageal reflux. Methods Seventy-three patients with established cirrhosis and an episode of variceal bleeding controlled by one session of endoscopic therapy were randomized to treatment with sclerotherapy or ligation until variceal eradication. In 60 of these patients, oesophageal manometry and 24-h intra-oesophageal pH monitoring were performed at inclusion and I month after variceal eradication. Results After variceal eradication with sclerotherapy, peristaltic wave amplitude decreased from 76.2 +/- 14.7 mmHg to 61.6 +/- 17.7 mmHg (P= 0.0001), simultaneous contractions increased from 0% to 37.9% (P = 0.0008), and the percentage of time with pH &lt; 4 increased from 1.60 +/- 0.25 to 4.91 +/- 1.16% in channel 1 (P= 0.0002) and from 1.82 +/- 0.27 to 5.69 +/- 1.37% in channel 2 (P= 0.0006). In contrast, the above parameters were not disturbed with ligation. Conclusion Our data define the advantages of ligation over sclerotherapy with respect to post-treatment oesophageal dysmotility and associated gastrooesophageal reflux