Abstract:Background: Hepatic hydrothorax is defined as a significant pleural effusion in patients with liver cirrhosis and without underlying cardiopulmonary diseases. Treatment of hepatic hydrothorax remains a challenge at present. Methods: Herein we share our experiences in the treatment of 12 patients with hepatic hydrothorax by video-assisted thoracoscopic surgery (VATS). Repair of the diaphragmatic defects, or pleurodesis by focal pleurectomy, talc spray, mechanical abrasion, electro-cauterization or injection was administered intraoperatively, and tetracycline intrapleural injection was used postoperatively for patients with prolonged (>7 d) high-output (>300 ml/d) pleural effusion. Results: Out of the 12 patients, 8 (67%) had uneventful postoperative course and did not require tube for drainage more than 3 months after discharge. In 4 (33%) patients the pleural effusion still recurred after discharge due to end-stage cirrhosis with massive ascites. Conclusion: We conclude that the repair of the diaphragmatic defect and pleurodesis through VATS could be an alternative of transjugular intrahepatic portal systemic shunt (TIPS) or a bridge to liver transplantation for patients with refractory hepatic hydrothorax. Pleurodesis with electrocauterization can be an alternative therapy if talc is unavailable.
Background and Aim Ropeginterferon alfa‐2b is a novel mono‐pegylated, extra‐long‐acting interferon. It is administered infrequently and showed good tolerability and clinical activity for the chronic hepatitis B or C treatment in our previous Phase 2 clinical trials. This study aims to validate the potency and safety of this novel agent in a Phase 3 chronic viral hepatitis setting. Methods Patients with chronic hepatitis C genotype 2 were randomized to receive subcutaneous injections of ropeginterferon alfa‐2b biweekly or the conventional pegylated interferon alfa‐2b weekly for 24 weeks, combined with ribavirin. The primary endpoint was to assess the safety and antiviral potency of ropeginterferon alfa‐2b by the non‐inferiority in sustained virologic response at 12 weeks after treatment. Results A total of 222 patients were enrolled. Ropeginterferon alfa‐2b group showed a favorable safety profile. Side effects that were generally associated with prior interferon therapies, including neutropenia, asthenia, fatigue, alopecia, dizziness, decreased appetite, nausea, flu‐like symptoms including myalgia, pyrexia, and headache, and administration site reactions, were notably less in the ropeginterferon alfa‐2b group. The cumulative incidence of adverse events of special interest was also notably higher in the control group. The primary endpoint was met and ropeginterferon alfa‐2b showed a better SVR12 rate of 79.8% than 71.9% of the control group. Conclusion Ropeginterferon alfa‐2b is efficacious and has a favorable safety profile as compared with the conventional pegylated interferon alfa‐2b. This study together with previous Phase 2 data validated ropeginterferon alfa‐2b to be a new treatment option for chronic hepatitis C genotype 2.
The diagnosis and management of gastrointestinal subepithelial tumors (GI SETs) have been under debate because of the low biopsy yield rate and risk of surgery. Owing to the advancement in endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER), GI SETs may be resected under acceptable risk, and the nature of GI SETs can be studied. However, the efficacy of endoscopic resection in the diagnosis and management of GI SETs remains unclear. We present our single-hospital experience of resecting GI SETs with ESD and STER to explore the efficacy of this technique and the nature of GI SETs. Thirty-nine patients with GI SETs who underwent ESD and STER were analyzed retrospectively. Patients' clinical data, procedure parameters, pathologic diagnosis, and outcomes were collected and analyzed. Thirty-nine GI SETs were resected, 36 by ESD, and 3 by STER. Thirty-eight (97.4%) tumors were from the submucosal layer and one from the muscular layer. Fifteen, 13, and 11 tumors were located in the esophagus, stomach, and colon, respectively. The mean tumor size was 16.8 ± 1.3 mm. In the esophagus, leiomyomas were the most common diagnosis, followed by the lymphoepithelial cyst, epithelial hyperplasia, focal lymphoid hyperplasia, and dilated submucosal gland. The esophageal tumor from the muscularis propria was GI stromal tumor (GIST). In the stomach, 53.8% of the submucosal tumors were ectopic pancreas, followed by lipoma, calcifying fibrous tumor, GIST, submucosal inflammation, and angiodysplasia with focal ulcers. The submucosal tumors in the colon were diagnosed as neuroendocrine tumors (NETs, n = 5), lipomas (n = 4), leiomyoma (n = 1), and foreign body-related granuloma (n = 1). Seven (17.9%) of all tumors were NETs and GISTs with malignant potential. All cases were resected completely. The overall procedural time was 37.9 ± 4.6 minutes. Severe fibrosis was more likely encountered in the stomach with a rate of 46.1%, with the gastric ectopic pancreas having a 71.4% severe fibrosis rate. Only 13 patients completed follow-up endoscopic ultrasound or endoscopy within 1 year after ESD and STER, and no recurrence was noted. There were no major complications, and none of the patients required admission to the intensive care unit or surgery. Three perforations were encountered during STER, which were smoothly
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