phylactic endoscopic variceal ligation (EVL) might be an ideal To determine the efficacy of endoscopic variceal ligatherapy. [13][14][15][16][17] tion (EVL) in prophylaxis on the rate of first esophageal The present study was thus designed to determine, in a variceal bleeding, we conducted a prospective, randomcontrolled and prospective manner, whether EVL therapy of ized trial in 126 cirrhotic patients with no history of high-risk varices will affect the risk of first variceal bleeding previous upper gastrointestinal bleeding and with and improve chances of survival of cirrhotic patients with no esophageal varices endoscopically judged to be at high previous bleeding from the upper gastrointestinal tract. risk of hemorrhage. The end-points of the study were bleeding and death. Life- 62) in the EVL group and 58% (37/64) in the controlfrom the study. Patients were randomly allocated to either a treat- group. Comparison of Kaplan-Meier estimates of thement group or to a control group (using a sealed-envelope method). time to death of both groups showed significantly lowerAll patients were informed of endoscopic findings and possible risks. mortality in the ligation group (P Å .001). Patients under-Patients in the treatment group were informed about study protocol going EVL had few treatment failures and died mainly and possible complications. Informed consent was obtained from each of hepatic failure. The lower risk in the EVL group was patient, and study protocol conformed to the ethical guidelines of the attributed to a rapid reduction of variceal size. Prophy-1975 Declaration of Helsinki, as reflected in a priori approval by the lactic EVL was more efficient in preventing first bleed-institution's human research review committee. Three patients who ing in patients with good condition (Child A) than in did not provide the consent were excluded from the study. Functional hepatic reserve was classified according to the Pugh-modified Childs those with decompensated disease (Child B and C). We classification. 18 The patients in Child class A were defined as having conclude that prophylactic EVL can decrease the inci-''compensated'' cirrhosis; the patients in Child classes B and C were dence of first variceal bleeding and death over a period defined as having ''decompensated'' disease. The successful control of corresponded to a rate of bleeding ú90.2% in the retrospective classimassive bleeding is the major goal of the emergency manage-fication of the study by Beppu et al. 20 This means that all patients ment of such patients. 4 However, the high mortality rate as-had blue varices of F2 or F3 size with at least one of the following: sociated with bleeding esophageal varices has not been signif-red wale markings (//, ///), cherry-red spots (//, ///), or heicantly reduced over the past decades, despite the enormous matocystic spots (/). Active variceal bleeding was diagnosed when blood was seen directly by endoscopy to issue from a varix, or when progress in pharmacological therapy and surgery. (Olympus XQ 20, To...

Objective To assess the efficacy and safety of aspirin desensitisation in Chinese patients with coronary artery disease. Design Case series.Setting A regional hospital in Hong Kong.Patients Chinese patients with coronary artery disease and a history of a hypersensitivity reaction to aspirin or non-steroidal antiinflammatory drug, who underwent aspirin desensitisation between February 2008 and July 2012.Results There were 24 Chinese patients with coronary artery disease who were admitted to our unit for aspirin desensitisation during this period. The majority (79%) were clinical admissions for desensitisation; eight (33%) of them developed a hypersensitivity reaction during desensitisation. Half of the latter had only limited cutaneous reactions and were able to complete the desensitisation protocol and developed aspirin tolerance. Overall, 20 (83%) of the patients were successfully desensitised at the initial attempt.No serious adverse reactions occurred in the cohort. Twelve of the patients had significant coronary artery disease revealed by coronary angiography and received a percutaneous coronary intervention, nine of whom received drug-eluting stents while three received bare metal stents due to financial constraints. All 11 successfully desensitised patients received aspirin and clopidogrel as double antiplatelet therapy after percutaneous coronary intervention. The remaining patient had a bare metal stent implant due to failed aspirin desensitisation. ConclusionGiven the potentially different genetic basis of aspirin hypersensitivity in different ethnicities, recourse to desensitisation in the Chinese population has not previously been addressed. This study demonstrated that aspirin desensitisation using a rapid protocol can be performed effectively and safely in Chinese patients. Our results were comparable to those in other reported studies involving other ethnicities. Successful aspirin desensitisation permits patients to pursue long-term double antiplatelet therapy that includes aspirin after percutaneous coronary intervention, and thus allows the use of drug-eluting stents as a feasible option.

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Patients with psoriatic arthritis (PsA) are at increased risk of infection due to disease course or treatment-related immunodeficiency. We describe a patient with a 10-year history of PsA, with arthritis of the right knee and pain and edema in the right calf, treated with the TNFα inhibitor etanercept for 6 months. Ultrasound showed accumulation of hypoechoic fluid, which was aspirated and was positive for staphylococcus and aspergillus. The patient recovered after surgical drainage and four weeks of antibiotic and antifungal therapy.