Management of hepatic hydrothorax is difficult and oftenHepatic hydrothorax is a rare complication of portal results in iatrogenic complications. Repeated thoracentesis, hypertension. Conservative therapy may be successful chest tube thoracostomy, pleurodesis, and peritoneovenous but refractory hepatic hydrothorax is not uncommon.shunt have been used with varying degrees of success. HowManagement of refractory hydrothorax is usually inefever, there have been many reports of failure and complicafective and can result in a worsened clinical status.tion with each of these procedures. [7][8][9] The only definitive Transjugular intrahepatic portosystemic shunts (TIPS) treatment is liver transplantation. lower portal pressure and have been used in the treatTransjugular intrahepatic portosystemic shunt (TIPS) rement of refractory ascites. The aim of this study was duces portal pressure and has been reported to improve the to determine the efficacy of TIPS in the treatment of control of refractory ascites in cirrhotic patients. [10][11][12] The goal symptomatic refractory hepatic hydrothorax. A TIPS was placed in 24 consecutive cirrhotic patients with of this study was to determine if the reduction in portal pressymptomatic refractory hepatic hydrothorax. Five pa-sure by TIPS improved the control of symptomatic hepatic tients (20.8%) were Child's/Pugh class B and 19 (79.2%) hydrothorax. Additionally, we evaluated the effect of TIPS in were class C. All had undergone multiple thoracenteses these patients on the Child's-Pugh class and the need for and were hypoalbuminemic. Mean follow-up was 7.2 orthotopic liver transplantation. The Child's-Pugh score improved in 7 (58.3%) of these 12candidates. All acceptable alcoholic liver transplantation candidates patients and two patients improved from class C to class were considered to have been abstinent for at least 6 months. A. These two patients no longer require liver transAll patients had clinical, laboratory, and radiologic evidence of plantation. This study shows that TIPS can be effective liver disease and portal hypertension. All patients had persistent in the management of symptomatic, refractory hepatic right-sided hydrothorax despite sodium and fluid restriction and the hydrothorax. Clinical and laboratory improvement may use of the maximum tolerable doses of diuretics. Diuretic use was be seen and liver transplantation may become unneces-limited by progressive azotemia, electrolyte imbalance, and hypotension. Infectious causes of hydrothorax were ruled out by fluid analysary. (HEPATOLOGY 1997;25:1366-1369.) sis and culture. Only patients with pulmonary symptoms, such as dyspnea and orthopnea, were enrolled in the study. All patients had Hepatic hydrothorax is the accumulation of ascitic fluid undergone multiple thoracenteses before transfer to our hospital. in the pleural space. It occurs in 0.4% to 12.2% of cirrhotic Five patients had chest tubes in place draining at least 4 L/d. Atpatients.1-3 The precise pathogenetic mechanisms remain un-tempts to remove or clamp ...

The transjugular intrahepatic portosystemic shunting procedure is an effective modality in the therapy of cirrhotic patients with bleeding stomal or anorectal varices unresponsive to conservative management. There is an acceptable procedure-related morbidity and mortality.

Current procedural recommendations for fellowship training may underestimate the technical skill necessary for independent GI practice upon completion of fellowship. Technical proficiency in snare polypectomy may lag behind proficiency in cecal intubation.

The n-3 fatty acids (C20:5, eicosapentaenoic acid; c22:6, docosahexaenoic acid) may be important in the development, growth, and metastasis of colon cancer, a leading cause of death in North America. Patients who have had a bowel neoplasm have a high risk of developing a second neoplasm, and this risk is associated with a high percentage of cells correspond to the S phase of bromodeoxyuridine (BrdUrd) labeling in mucosal epithelial cells. To determine the effect of n-3 fatty acid supplementation on DNA synthesis of rectal mucosa, patients with stage 1 or stage 2 colon carcinoma or adenomatous polyps were randomized to consume either 9 g/d n-3 fatty acid capsules or 9 g/d placebo capsules. Plasma phospholipid fatty acid analysis and proctoscopic mucosal biopsies were performed at baseline, 3, and 6 mon. Colonic crypts were isolated from the mucosa, disassociated with enzymes, and incubated with BrdUrd, and %S phase was measured by flow cytometry. The plasma phospholipid n-6/n-3 ratio was determined by gas chromatography. Supplement compliance was assessed by plasma phospholipid n-6/n-3 ratio. Mean capsule consumption in these two group was 82%. Prior to supplementation, there were no significant differences in the %S phase and the plasma n-6/n-3 ratio between these groups. Patients whose colonic epithelial cells indicated hyperproliferation at baseline showed a strongly positive correlation to the %S phase of BrdUrd uptake and the n-6/n-3 ratio. There was no significant change after n-3 treatment in patients with low baseline. Those in the placebo group showed no significant difference in n-6/n-3 ratio, although there was an increase in the %S phase of BrdUrd uptake at 6 mon. The n-3 group did not have significant side effects, and polyps were not found after completing 12 mon of n-3 fatty acid supplementation. This study suggests that n-3 fatty acid may be a useful chemopreventive agent in some patients as reflected in a plasma biomarker of colon tumor growth and metastasis. A low plasma phospholipid n-6/n-3 fatty acid ratio may serve as a nutritional marker that is associated with colonic epithelial cell hyperproliferation in the n-3-supplemented group as compared with the placebo group. Characteristics of mucosal proliferation at baseline may be a crucial factor for the effect of n-3 fatty acid supplementation.