Fundal variceal bleeding treated with balloon occluded endoscopic inyection sclerotherapy. Report of two cases

Management of gastrointestinal bleeding caused by fundal varices is particularly difficult to manage. The options are: transjugular intrahepatic portosystemic shunt (TIPS), endoscopic injection of cyanoacrylate or balloon-occluded retrograde transvenous obliteration (BRTO). We report a 63 year-old male with a cirrhosis caused by hepatitis C and a 66 year-old female with a cirrhosis caused by a non-alcoholic steatohepatitis. Both patients had a gastrointestinal bleeding caused by fundal varices and were treated with sclerotherapy with cyanoacrylate assisted with BRTO. Flow was interrupted in the gastro-renal shunt by a femoral access in both patients. The male patient had a new bleeding two months later and died. In the female patient an endosonography performed nine months after the procedure showed absence of remaining varices

Comparison of the clinical efficacy of two different immunosuppressive regimens in patients with chronic Vogt-Koyanagi-Harada disease

Purpose: To prospectively compare 2 immunosupressive regimens in patients with active Vogt-Koyanagi-Harada disease in spite of systemic glucocorticoid treatment. Methods: Forty-four patients were diagnosed between 1998 and 2005. Twenty-one developed chronic intraocular inflammation in spite of glucocorticoid treatment and were randomized to receive either prednisone and azathioprine (AZA) (n = 12) or prednisone and cyclosporine (CyA) (n = 9). Results: In the AZA group Tyndall score decreased from 1.21±1.10 to 0.29±0.62 (p<.01), and visual acuity (LogMAR) improved from 0.32±0.35 to 0.09±0.16 (p<.001). In the CyA group Tyndall score decreased from 1.67±1.08 to 0.16±0.51 (p<.001), and visual acuity improved from 0.41±0.40 to 0.25±0.42 (p<.001). Patients in the AZA group needed a significantly higher average prednisone dose and total cumulative dose than those in the CyA group, p<.01 for each comparison. Conclusions: Both regimens showed a good clinical efficacy, but CyA seems to be a bet