AB1231 ULTRASOUND-GUIDED INJECTION OF LOW MOLECULAR WEIGHT HYALURONIC ACID VERSUS STEROID FOR INFLAMMATORY AND DEGENERATIVE SACROILIITIS: A RANDOMIZED CONTROLLED TRIAL

Background

Sacroiliitis may be degenerative (DSI) or inflammatory (ISI) and the latter is one of the clinical features of spondyloarthropathies.

Objectives

To determine the effect of hyaluronic acid versus corticosteroid injection for chronic sacroiliac joint arthropathy.

Methods

forty patients with sacroiliitis either degenerative (DSI: 20 patients) or inflammatory (ISI: 20 patients) based on the New York criteria. Each group was allocated into 2 subgroups; 10 patients received 2ml Betamethasone dipropionate plus 2 ml lidocaine 2% (A) and 10 patients received 2 ml hyaluronic acid plus 2 ml lidocaine 2% (B). All sacroiliac joint injections were done under ultrasonographic guidance using a 22-gauge needle. Visual analogue scale was used for pain assessment at base line, 1, 2 and 4 week post injection.

Results

there was no significant difference between main groups (ISI & DSI) regarding VAS score before injection, 1, 2 and 4 weeks after injection while there was a significant difference between subgroups A&B in ISI group at 2 and 4 weeks (P= 0.012 and 0.008 respectively). Also, there was a significant difference between subgroups A & B in DSI group at 1, 2 and 4 weeks after injection (P= 0.04, 0.006, and 0.005 respectively). There was a high significant difference before and after injection in the main groups and all subgroups. However, there was no significant difference between the subgroups of ISI and DSI.

Conclusion

both steroid and hyaluronic acid were effective in relieving pain in treatment of inflammatory and degenerative sacroiliitis but steroid was more efficacious than the hyaluronic acid.

Disclosure of Interests

Khalid Hosny: None declared, Mohamed Ismail Abdelkareem Speakers bureau: Abbvie, Jansen, Novartis and Organon, Abdelhfeez Moshrif Speakers bureau: Amgen, Jansen and Novartis

Urinary schistosomiasis presented as bladder malignancy with pulmonary metastases: a case report

Schistosoma haematobium is the species primarily responsible for the manifestation of schistosomiasis in the genitourinary tract. It is a parasitic disease caused by flukes (trematodes) of the genus Schistosoma, which can result in acute and chronic manifestation. We report a case of urinary schistosomiasis that initially presented as advanced bladder cancer with pulmonary metastasis on initial computed tomography scan. Further investigations revealed no cancer and pulmonary changes resolved with treatment. The involvement of bladder is the hallmark of S. haematobium infection and it is unusual to have pulmonary manifestation without concurrent hepatosplenic disease. Within the lungs, deposition of Schistosoma eggs causes a granulomatous reaction, typically producing miliary nodules on chest radiographs. In our case, this was interpreted initially as lung metastases. However, given the cystoscopic findings and subsequent resolution with praziquantel, this was proved otherwise. This case highlights the importance of urinary cytology in the initial investigation of haematuria. Clinicians should be aware of such a potential differential diagnosis, especially in patients with prior travel history to endemic areas.

Exploring Portal Vein Hemodynamic Velocities as a Promising, Attractive Horizon for Small-for-Size Syndrome Prediction After Living-Donor Liver Transplantation: An Egyptian Center Study

BACKGROUND

Liver transplantation is the only definite treatment for patients with irreversible liver failure. This explored the impact of portal vein hemodynamic velocities on graft functions to determine the mean portal vein velocities that may increase small-for-size syndrome (SFSS) risk.

METHODS

The study was conducted with 123 cirrhotic patients who underwent living-donor liver transplantation (LDLT) at Kasr Alainy Hospital, Cairo, Egypt. Patients were submitted to full history, examination, pre-transplantation labs, and imaging. Intra-operative Doppler studies were performed after graft reperfusion. Post-operative (PO) Doppler was performed once a day over the first 2 weeks. Complete graft functions were obtained daily for patients.

RESULTS

PVV (portal vein velocities) declined gradually but significantly after LT (intra-operative), and PO PVV were significantly higher in the SFSS group. The best cut-off values for prediction of SFSS with the use of intra-operative (before, during, and after) post-anastomotic PVV were 55.5, 106, and 126.5 cm/s, respectively, and, for PO before and after anastomotic PVV, 48.6 and 71.1 cm/s, respectively. There was a significant positive correlation between PO mean PVV and mean alanine transferase, total bilirubin, and international normalized ratio.

CONCLUSIONS

PVV is a significant hemodynamic factor that influences graft functions. SFSS, which has a negative impact after LDLT, could be predicted by cut-off values for PVV, and therefore preventive measures such as splenectomy may be considered for its prevention.

Intra-operative Ultrasound-guided Thrombectomy and Thrombolysis for Post-operative Portal Vein Thrombosis in Living Liver Donors

There are few reports of portal vein thrombosis among living donor liver transplant donors and no published data on the management of this event. In this report, we present our experience in the diagnosis and management of this rare complication in two living donor liver transplantation donors who developed post-operative portal vein thrombosis. Both cases were successfully managed with intra-operative ultrasound-guided thrombectomy, vein patch venoplasty, and catheter-directed thrombolysis. The two donors are symptom-free two years after the event.