1. Novel Sonar Techniques For Patients Awaiting Liver Transplantation
Abd Elrazek M Ali1, Ahmed Elshamy2, Khaled Salama3, Ramy Abd Elmasseih4
Aswan School of Medicine, Aswan University-Aswan, Egypt 2- Mount Sinai School of Medicine, NY, USA 3- Ministry of Health, Alwadi al Gadeed Egypt 4-UCLA, Los Angeles USA
Background and Aim: Umbilical hernias and esophageal varices pose management dilemma in patients with cirrhosis, especially those awaiting liver transplantation. Complications of umbilical hernias in cirrhotic patients with Portal Hypertension include leakage, ulceration, rupture and incarceration thus leading to a higher mortality rate after surgical repair. Additionally patients need follow up for screening esophageal varices while on the waiting for liver transplantation , eventually is a burden on Endoscopy units.. However, as the waiting time prior to liver transplantation is prolonged, the likelihood of rupture varices and an incarcerated hernia developing is increased, both affect the overall transplant outcome. Here, we investigated the feasibility of 2D U/S to predict esophageal varices and to repair incarcerated hernia, using Sonar guided Novel technique.
Patients and Methods: Following the recommendations of a recent study entitled 'Prior to the oral therapy, what do we know about HCV-4 in Egypt: a randomized survey of prevalence and risks using data mining computed analysis. medicine®, Baltimore, USA, 2014 Dec;93(28) , the intra-abdominal portion of the esophagus of 650 patients who presented with manifestations of decompensated liver with MELD score > 14 were examined using standard two-dimensional ultrasound (US) to evaluate cost effectiveness, standard issues, and medical benefits using conventional US. Additionally 23 patients of those patients presented with Incarcerated Umbilical hernia.
Results: The overall effectiveness analysis of 650 patients yielded a 41% cost standard benefit calculated to be $114,760 in a 6-month study. However the overall success to predict Esophageal varices using 2D U/S was 95% and to treat patients with Incarcerated hernia was 73.9 %.
Conclusion: To our knowledge, this is the first ever report to describe cost effectiveness value of 2D U/S technique for Esophageal varices prediction and sonar guided manipulation for fixing incarcerated umbilical hernia. Thus, this described procedure can be either a safe alternative Screening Endoscopy / Interventional Surgery or at least as a bridge for later safe elective Endoscopy / Surgery in patients awaiting for liver transplantation.
We succeeded in 20 out of 23 patients; 73.9 %
Beore
After .
After
Irreducible &
Inflamed
After 3 Hours Using U/S Technique; Reducible & Painless
Before
REFERENCES
1- Abd Elrazek AE, Shymaa Bilasy, El banna Abuh, AbdElhalim Elsherif ; Prior to the oral therapy, what do we know about HCV-4 in Egypt: a randomized survey of prevalence and risks using data mining computed analysis. medicine®, Baltimore, USA, 2014 Dec;93(28)
2-Abd Elrazek AE, Mahfouz Hamdy M, Afifi M, et al. Detection of risky esophageal varices by two-dimensional ultrasound: when to perform endoscopy. Am J Med Sci. 2014;347:28.
3- Aly abd Elrazek Abd Elrazek M, Mahfouz HM. Prediction analysis of esophageal variceal degrees using data mining: is validated in clinical medicine? Global J Comput Sci Technol. 2013;13:1–5.
4-Abstract Entitled; Novel Sonar Guided Technique in management of Incarcerated Umbilical Hernia in patients awaiting Liver Transplantation; Abd Elrazek m Aly, Mahfouz Hamdy, Mohammad Nafady, Shymaa Bilasy; AASLD November 2015 (Accepted; Poster &ePoster)
Primary and pre-primary prophylaxis against variceal hemorrhage in patients with cirrhosis.
Reference 15; Abd Elrazek MA, Mahfouz H, Afifi M, et al. Detection of risky esophageal varices by two-dimensional ultrasound: when to perform endoscopy. Am J Med Sci 2014; 347:28.