Predictive Factors For Treatment Failure Research Articles

Treatment with direct-acting antiviral agents of hepatitis C virus infection in injecting drug users: A prospective study.

In this prospective study, we evaluated the effectiveness and tolerability of novel therapies against hepatitis C virus (HCV) in a cohort of PWID enrolled at our centre from April 2015 to July 2016. In this analysis, a total of 174 patients were included: eleven (6.3%) were treated with pegylated interferon (PEG-IFN) and ribavirin (RBV) containing regimens, 163 (93.7%) with IFN-free treatments. RBV has been used in 70 patients (40.2%); 59 (33.9%) patients were in opioid substitution therapy (OST) with methadone or buprenorphine. Overall, sustained virological response (SVR) has been observed in 162 subject (93.1%), breakthrough (BT) in three (1.7%), relapse in one (0.6%) and dropout in eight (4.6%). Treatment was interrupted for clinical conditions in seven patients: six (3.4%) had hepatic decompensation and one died for hepatocellular carcinoma (HCC). In multivariate analysis, predictive factors of treatment failure were as follows: albumin level below 3g/dL (OR=7.190; 95% IC=1.236-41.837; P<.001), MELD score >10 (OR=5.886; 95% IC=1.411-35.994; P<.001) and years of HCV infection >20 (OR=1.286; 95% IC=0.556-9.455; P=.016). In conclusion, treatment with DAAs was effective and well tolerated in PWID; cirrhotic subjects with MELD>10 and albumin low level showed a higher risk of developing serious adverse events and treatment failure.

Transarterial chemoembolization for early stage hepatocellular carcinoma decrease local tumor control and overall survival compared to radiofrequency ablation.

Background & AimsTo compare treatment failure and survival associated with ultrasound-guided radiofrequency ablation (RFA) and trans-arterial chemoembolization (TACE) for early-stage HCC in Child-Pugh A cirrhosis patients.Methods122 cirrhotic patients (RFA: 61; TACE: 61) were well matched according to cirrhosis severity; tumor size and serum alpha-fetoprotein. TACE was performed in case of inconspicuous nodule on US or nodule with “at risk location”. Treatment failure was defined as local tumor progression (LTP) and primary treatment failure (failing to obtain complete response after two treatment session). Treatment failure and overall survival (OS) were compared after coarsened exact matching. Cox proportional model to assess independent predictive factors was performed.ResultsNo significant difference was seen for baseline characteristics between the two groups. Mean tumor size was 3cm in both group with 41% HCC>3cm. Treatment failure rates after TACE was 42.6% (14 primary treatment failures and 12 LTP) and 9.8% after RFA (no primary treatment failure and 6 LTP) P < 0.001. TACE was the only predictive factor of treatment failure (Hazard ratio: 5.573). The 4-years OS after RFA and TACE were 54.1% and 31.5% (P = 0.042), respectively.ConclusionFor Child-Pugh A patients with early-stage HCC, alternative treatment as supra-selective TACE to RFA regarded as too challenging using common US guidance decrease significantly the local tumor control and overall survival. Efforts to improve feasibility of RFA especially for inconspicuous target have to be made.

Multidrug resistance protein 4 is a critical protein associated with the antiviral efficacy of nucleos(t)ide analogues.

Multidrug resistance protein 4 (MRP4) has been associated with nucleos(t)ide analogue (NA) antiretroviral therapy failure, though is unclear if MRP4 is also correlated with the failure of anti-hepatitis B virus (HBV) therapy. Multidrug resistance protein 4 expression in human peripheral blood mononuclear cells (PBMCs), liver tissues and human hepatoma cell lines was detected by real-time polymerase chain reaction (PCR), western blotting and immunohistochemistry assays. Supernatant and intracellular HBV DNA levels of MRP4-overexpressing or silenced HepG2.4D14 (wild-type) and HepG2.A64 (entecavir-resistant mutant) cells were measured by quantitative PCR. NA concentrations and HBV mutational analysis were assessed by liquid chromatography/mass spectrometry assays and DNA sequencing. Multivariate analysis was used to assess predictive factors for treatment failure. High expression of MRP4 was found in hepatoma cell lines and PBMCs, and up- or down-regulation of MRP4 expression altered the susceptibility of cells to NAs. MRP inhibitors increased NA intracellular accumulation and decreased extracellular levels. Moreover, MRP4 expression in PBMCs was correlated with that in paired liver tissues. Furthermore, multivariate analysis showed MRP4 mRNA expression to be an independent predictor of NA treatment failure. Multidrug resistance protein 4 is a critical protein associated with the antiviral efficacy of NAs, and combination therapy of NA and MRP inhibitors could reduce the dosage for long-term NA use. This is the first report to demonstrate that MRP4 expression is an important factor predicting treatment failure in chronic hepatitis B patients and will provide a potential therapeutic target against HBV.

Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged ≥ 65 years.

Both peroral endoscopic myotomy (POEM) and pneumatic dilation (PD) has proved to be effective for treating achalasia in patients aged ≥ 65 years. However little is known about the comparison between POEM and PD. The aim of the study was to compare the safety and efficacy of POEM and PD for the treatment of achalasia in these patients. We retrospectively reviewed the medical records of patients aged 65 years-old or more who received POEM or PD for the treatment of achalasia at our hospital from January 2010 to December 2015, they were divided into the POEM group and the PD group. Demographics and data about safety and efficacy were collected retrospectively and compared between the two groups. A total of 31 patients were enrolled, and 21 of them received POEM, while the other 10 received PD. The treatment success (Eckardt score ≤ 3) rate of POEM and PD at 3, 6, 12, 24 and 36 months after the treatment were comparable (p > 0.05). Treatment failure was noticed in 3 cases, 1 of them was in the POEM group and the other 2 in the PD group, there was no significant difference (p > 0.05). Multivariate analysis showed that sigmoid-type achalasia was a predictive factor of treatment failure. No severe complications were observed during operation and periodical follow-up. Short-term and intermediate efficacy of POEM and PD for treating achalasia in patients aged ≥ 65 years was comparable. A large scale, randomized study with long-term follow-up is necessary in order to make a definitive conclusion.

Predictive factors for treatment failure in patients with presumed ocular tuberculosis in an area of low endemic prevalence

AimTo assess the impact of antitubercular therapy (ATT), oral steroids and steroid sparing immunosuppressive treatment on treatment success in cases with presumed ocular tuberculosis in an area of low endemic...

Photoselective Vaporization of the Prostate in Men With Refractory Urinary Retention

To assess the efficacy of photoselective vaporization of the prostate (PVP) and the predictive factors of treatment failure in patients with refractory urinary retention. From January 2006 to December 2013, we prospectively included all patients treated by PVP preoperatively catheterized for urinary retention. The primary end point was the number of patients free of indwelling catheters 3 months after the procedure. Univariate and multivariate analyses were performed to identify the predictive factors of treatment failure. One hundred fifty-two patients were included in the final analysis. The percentage of patients free of indwelling catheters was 91.5% 3 months after PVP. Two factors were identified as predictive of treatment failure at 3 months in multivariate analysis: a smaller preoperative ultrasonographic prostate volume (UPV; odds ratio [OR] = 0.91; P = .008) and a higher volume of primary urinary retention (OR = 1.03; P = .003). Forty-two patients (27.6%) required early recatheterization within 7 days after surgery. Smaller UPV was the only predictive factor of treatment failure in the early postoperative in multivariate analysis (OR = 0.97; P = .01). Nearly one-third of patients treated for refractory urinary retention fail the first trial without catheter after PVP, but 91.5% are free of indwelling catheter 3 months after surgery. A smaller preoperative UPV and a higher retention volume were predictive of PVP failure in patients with preoperative indwelling catheters.

The prediction of treatment failure of the continuous positive airways pressure.

The aim of study was to find predictive factors for treatment failure of the continuous positive airway pressure (CPAP). Sleep apnea syndrome (SAS) affects 4-8 % of the general population. Despite good adherence, CPAP is ineffective in about 13 % of patients. In those patients, a higher level of treatment by bilevel positive airway pressure (BiPAP) has to be used. Totally, 983 patients with moderate to severe SAS (AHI ≥ 15, apnea/hypopnea index) were treated with CPAP during 2005-2010 in a tertiary hospital. 506 patients fulfilled the inclusion criteria. In all patients, sleep monitoring was performed and AHI, the presence of hyposaturation T90 (oxygen saturation less than 90 %) and ODI (oxygen distress index) were recorded and a comparison was made between CPAP-effective and CPAP-failure treatment groups. Of all the variables evaluated, only T90 significantly predicted the failure of CPAP treatment. A T90 value above 43.5 % predicted CPAP failure in 94.5 % of patients regardless of age. The value of T90 enables the determination of patients who will not benefit from CPAP treatment and BiPAP should be used as a treatment of the first choice (Tab. 2, Fig. 1, Ref. 31).

Pseudomonas aeruginosa Ventilator-associated Pneumonia. Predictive Factors of Treatment Failure

The predictive factors of treatment failure for ventilator-associated pneumonia (VAP) caused by Pseudomonas aeruginosa (PA) remain uncertain. To describe PA-VAP recurrence prognosis and to identify associated risk factors in a large cohort of intensive care unit patients with PA-VAP. From the multicenter OUTCOMEREA database (1997-2011), PA-VAP onset and recurrence were recorded. All suspected cases of VAP were confirmed by a positive quantitative culture of a respiratory sample. Multidrug-resistant PA strains were defined by the resistance to two antibiotics among piperacillin, ceftazidime, imipenem, colistine, and fluoroquinolones (FQ). An extensively resistant PA was defined by resistance to piperacillin, ceftazidime, imipenem, and FQ. A treatment failure was defined as a PA-VAP recurrence or by the death occurrence. A total of 314 patients presented 393 PA-VAP. Failure occurred for 112 of them, including 79 recurrences. Susceptible, multidrug resistant, and extensively resistant PA represented 53.7%, 32%, and 14.3% of the samples, respectively. Factors associated with treatment failure were age (P = 0.02); presence of at least one chronic illness (P = 0.02); limitation of life support (P = 0.0004); a high Sepsis-Related Organ Failure Assessment score (P < 0.0001); PA bacteremia (P = 0.003); and previous use of FQ before the first PA-VAP (P = 0.0007). The failure risk was not influenced by the strain resistance profile or by the biantibiotic treatment, but decreased in case of VAP treatment that includes FQ (subdistribution hazard ratio, 0.5 [0.3-0.7]; P = 0.0006). However, the strain resistance profile slowed down the intensive care unit discharge hazard (subdistribution hazard ratio, 0.6 [0.4-1.0]; P = 0.048). Neither resistance profile nor biantibiotic therapy decreased the risk of PA-VAP treatment failure. However, the profile of PA resistance prolonged the length of stay. Better evaluation of the potential benefit of an initial treatment containing FQ requires further randomized trials.

The control and prognostic factors analysis of acute gastroesophageal variceal hemorrhage

Objective To analyze the correlation between the bleeding control time,treatment and prognosis in acute gastroesophageal variceal hemorrhage and to explore the predictive factors in treatment failure.Methods The clinical data of 309 patients with acute gsstroesophageal variceal hemorrhage was collected.The bleeding control was retrospectively analyzed within and at two hours after treatment,over two hours but less than six hours,over six hours but less than five days,at and after five days.The correlation between bleeding control time and mortality rate was analyzed.The differences in success rate of bleeding control and mortality rate between medication treatment alone and medication combined with endoscopic treatment were compared.Logistic regression mode was used to analyze the predictive factors of treatment failure.Results Of the 309 acute gastroesophageal variceal hemorrhage hospitalized patients,the failure of bleeding control within and at two hours,over two hours but less than six hours and over six hours but less than five days were 79 cases,25 cases and 26 cases respectively and there were one,four and 16 cases who died respectively.The success rate of bleeding control by medication treatment alone was 57.93％ (179/309) and the mortality was 10.36％ (32/309). The success rate of bleeding control by medication combined with treatment under endoscope was 82.35％ (28/34) and the mortality rate was 0.The results of Logistic regression mode analysis indicated that the admission systolic blood pressure (≤90 mm Hg,1 mm Hg=0.133 kPa),increase of total bilirubin,increase of Child-Pugh grade and ascites were the predictive factors of treatment failure.Conclusions The time of bleeding control failure mostly was within two hours.With time extended,the mortality increased. The success rate of bleeding control by medication combined with endoscopic treatment was higher and the mortality was lower.The admission systolic blood pressure lower than 90 mm Hg,increase of total bilirubin,increase of Child-Pugh grade and ascites may be the predictive factors of treatment failure. Key words: Esophageal and gastric varices; Gastrointestinal hemorrhage; Prognosis; Endoscopy

Botulinum toxin A for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients

Neurogenic detrusor overactivity (NDO) is common in patients who suffer from multiple sclerosis (MS). When the usual pharmacological treatment fails, botulinum toxin type A (BTX-A) injections can be proposed. The safety and efficacy of this treatment are already well known, but only a few studies focus on its use in patients with MS. Seventy-one patients with MS underwent their first BTX-A injection for refractory NDO. They had clinical and urodynamic cystometry assessment before and three months after injection. The patients were divided in three groups according to treatment efficacy: full success (total urinary continence, no overactive detrusor), improvement, or total failure (urge incontinence and overactive detrusor). 77% of the patients had clinical improvement or full success of the treatment with a reduction of their urgency and incontinence. Significant urodynamic improvement after treatment was shown on different parameters: volume at first involuntary bladder contraction (p = 0.0000001), maximum cystometric capacity (p = 0.0035), maximum detrusor pressure (p = 0.0000001). 46% of the patients were in the "full success" group. 31% of the patients had a partial improvement. 23% of the patients had no efficacy of the treatment. Duration of MS was a predictive factor of treatment failure (p = 0.015). Despite that a full success was obtained in 46% of the cases, BTX-A injection therapy failed to treat refractory NDO in 23% of patients suffering from MS. Duration of the disease was a predictive factor for an inefficient treatment. The injection therapy should be considered as soon as oral anti cholinergic drugs fail to reduce NDO.

Bacterial infection profiles in lung cancer patients with febrile neutropenia

BackgroundThe chemotherapy used to treat lung cancer causes febrile neutropenia in 10 to 40% of patients. Although most episodes are of undetermined origin, an infectious etiology can be suspected in 30% of cases. In view of the scarcity of data on lung cancer patients with febrile neutropenia, we performed a retrospective study of the microbiological characteristics of cases recorded in three medical centers in the Picardy region of northern France.MethodsWe analyzed the medical records of lung cancer patients with neutropenia (neutrophil count < 500/mm3) and fever (temperature > 38.3°C).ResultsThe study included 87 lung cancer patients with febrile neutropenia (mean age: 64.2). Two thirds of the patients had metastases and half had poor performance status. Thirty-three of the 87 cases were microbiologically documented. Gram-negative bacteria (mainly enterobacteriaceae from the urinary and digestive tracts) were identified in 59% of these cases. Staphylococcus species (mainly S. aureus) accounted for a high proportion of the identified Gram-positive bacteria. Bacteremia accounted for 60% of the microbiologically documented cases of fever. 23% of the blood cultures were positive. 14% of the infections were probably hospital-acquired and 14% were caused by multidrug-resistant strains. The overall mortality rate at day 30 was 33% and the infection-related mortality rate was 16.1%. Treatment with antibiotics was successful in 82.8% of cases. In a multivariate analysis, predictive factors for treatment failure were age >60 and thrombocytopenia < 20000/mm3.ConclusionGram-negative species were the most frequently identified bacteria in lung cancer patients with febrile neutropenia. Despite the success of antibiotic treatment and a low-risk neutropenic patient group, mortality is high in this particular population.

Facteurs prédictifs d’échec de cure d’incontinence urinaire d’effort masculine par bandelette sous-urétrale à ancrage osseux type InVance™ : étude multicentrique du comité des troubles mictionnels de l’homme de l’Association française d’urologie

To define predictive factors of treatment failure in a multicentric study for the treatment of stress male urinary incontinence by InVance (American Medical System, USA) bone anchored sub-urethral sling. Cases treated by InVance between January 2005 and December 2007 in four French academic centers were collected. Eighty-four patients were evaluated. Mean age was 68 years old. With a mean follow-up of 20 months, 38 patients (45%) were dry, 22 (26%) were improved, and 24 (29%) suffered treatment failure. In univariate analysis, three parameters were significantly associated with treatment failure, including severe urinary incontinence (P=0.005), urodynamic instability (P=0.043), and incontinence due to a bitherapy including external radiotherapy (P=0.031). If zero or one versus two or three risk factors were present, treatment failure rate was 25 and 67%, respectively (P=0.013). In multivariate analysis, bitherapy including radiotherapy was the sole independent treatment failure risk factor (P=0.017). Two patient groups were defined, allowing to determine preoperatively good candidates and bad candidates for stress urinary incontinence treatment by InVance sling.

A Randomized Trial Comparing Plasma Drug Concentrations and Efficacies between 2 Nonnucleoside Reverse‐Transcriptase Inhibitor–Based Regimens in HIV‐Infected Patients Receiving Rifampicin: The N2R Study

To our knowledge, to date, no prospective, randomized, clinical trial has compared standard doses of efavirenz- and nevirapine-based antiretroviral therapy among patients with concurrent human immunodeficiency virus type 1 (HIV-1) infection and tuberculosis (TB) who are receiving rifampicin. Rifampicin recipients with concurrent HIV-1 infection and TB were randomized to receive antiretroviral therapy that included either efavirenz (600 mg per day) or nevirapine (400 mg per day). Efavirenz and nevirapine concentrations at 12 h after dosing (C12) were monitored at weeks 6 and 12. CD4+ cell counts and HIV-1 RNA levels were assessed every 12 weeks. One hundred forty-two patients were randomized into 2 groups equally. The mean body weight of patients was 53 kg, the mean CD4+ cell count was 65 cells/mm3, and the median HIV-1 RNA level was 5.8 log10 copies/mL. At weeks 6 and 12, the mean C12 of efavirenz (+/- standard deviation) were 4.27+/-4.49 and 3.54+/-3.78 mg/L, respectively, and those for nevirapine were 5.59+/-3.48 and 5.6+/-2.65 mg/L, respectively. Interpatient variability in the efavirenz group was 2.3-fold greater than that in the nevirapine group (coefficient of variation, 107% vs. 47%). At week 12, 3.1% of patients in the efavirenz group and 21.3% in the nevirapine group had C12 values that were less than the recommended minimum concentrations (odds ratio, 8.396; 95% confidence interval, 1.808-38.993; P= .002). Intention-to-treat analysis revealed that 73.2% and 71.8% of patients in the efavirenz and nevirapine groups, respectively, achieved HIV-1 RNA levels <50 copies/mL at week 48, with respective mean CD4+ cell counts of 274 and 252 cells/mm3 (P> .05). Multivariate analysis revealed that patients with low C12 values and those with a body weight <55 kg were 3.6 and 2.4 times more likely, respectively, to develop all-cause treatment failure (P< .05). Antiretroviral therapy regimens containing efavirenz (600 mg per day) were less compromised by concomitant use of rifampicin than were those that contained nevirapine (400 mg per day) in patients with concurrent HIV-1 infection and TB. Low drug exposure and low body weight are important predictive factors for treatment failure.

The Therapeutic Effect of Cyanoacrylate on Gastric Variceal Bleeding and Factors Related to Clinical Outcome

Cyanoacrylate has been recommended for the treatment of gastric variceal bleeding. We aimed to evaluate the efficacy and safety of cyanoacrylate injection therapy in patients with gastric variceal bleeding, and to identify the factors predictive of failure, rebleeding, and survival after therapy. One hundred twenty-one patients with gastric variceal bleeding who received cyanoacrylate injections were retrospectively reviewed. Treatment succeeded in 110 patients (90.9%). Rebleeding and mortality rate during 4-week were 13.2% and 11.6%. A stepwise logistic regression analysis indicated that only the Child-Pugh class was an independent predictive factor of treatment failure [Child-Pugh C vs. Child-Pugh A and B, odds ratio (OR), 5.0; 95% confidence interval (CI), 1.2-19.4; P=0.025]. The actuarial probability of a 4-week absence of rebleeding and survival after the initial therapy was 86.8% and 85.1%, respectively. A stepwise logistic regression analysis showed that a Child-Pugh class C and hepatocellular carcinoma were independent predictive factors for rebleeding (OR, 7.4; 95% CI, 2.0-27.0; P=0.003 and OR, 3.3; 95% CI, 1.0-11.1; P=0.05, respectively) and mortality (OR, 7.4; 95% CI, 2.0-27.0; P=0.003 and OR, 3.3; 95% CI, 1.0-11.1; P=0.05, respectively). Only 2 cases (2.7%) with serious complications, noted as cyanoacrylate embolisms, were observed. At 1-year follow up, the actuarial probability of remaining free of bleeding was 49.0% and hepatitis B virus infection was independent predictive factor of bleeding (OR, 5.3; 95% CI, 1.4-20.0; P=0.015). In short-term follow-up, cyanoacrylate injection is an effective treatment method for gastric variceal bleeding and the Child-Pugh class was only independent predictive factor of treatment failure and the Child-Pugh class and the hepatocellular carcinoma were risk factors for rebleeding and survival. In long-term follow-up, the presence of hepatitis B infection was risk factor for rebleeding.

Nasolacrimal duct obstruction in children: Outcome of intubation

Nasolacrimal silicone intubation is a treatment for congenital nasolacrimal duct obstruction (NLDO) after failed probing and irrigation. Functional outcome has been previously reported as poorer in children with Down syndrome. The outcome of 122 cases of silicone bicanalicular nasolacrimal intubation, performed between 1988 and 2002 on 97 children aged 11 months to 9.5 years, was retrospectively reviewed. In all children, intubation was performed under direct vision using nasal endoscopy. Statistical analysis, including multiple logistic regression analysis, was used to assess the effects of duration of intubation, and age at surgery, on treatment outcome, and to determine potential predictors of treatment failure. The overall success rate was 85%, with 89% success for eyes in children with Down syndrome and 85% success for eyes in children without Down syndrome. Success rates were consistently high (83% to 100%) for children who underwent surgery between 1 and 4 years of age. The average duration of intubation was 5.5 months. Increasing duration of intubation was not associated with increasing chance of success, but with a significantly higher risk of failure if greater than 18 months (P = 0.03). Retention of stents for longer than 12 months was associated with a significantly lower success rate (67%). The presence of Down syndrome, increasing age at surgery, or gender were not predictive factors for treatment failure. Unplanned removal of tubes because of dislodgement was the most common complication, occurring in 25% of eyes, but did not affect functional outcome. Nasolacrimal silicone intubation, under direct nasal endoscopic visualization, is a consistently successful procedure for the treatment of NLDO among children aged older than 12 months of age. Tubing should be left in place for a maximum of 12 months because the success rate declines after this period and the risk of failure is significantly increased after 18 months of intubation. Prematurely dislodged tubes need not be replaced unless symptoms of nasolacrimal obstruction occur, because this does not lead to an increased risk of treatment failure.

33 OP Endoscopic and radiological patterns at admission are predictive factors for treatment failure in patients with severe ulcerative colitis

33 OP Endoscopic and radiological patterns at admission are predictive factors for treatment failure in patients with severe ulcerative colitis

4750 Efficacy of n-butyl 2-cyanoacrylate injection therapy for gastric variceal bleeding and the factors related to its clinical outcome.

Background and Aims: Cyanoacrylate has been used for the control of bleeding from gastric varices. The aim of the study was to evaluate the efficacy and the safety of n-butyl 2-cyanoacrylate injection therapy for gastric variceal bleeding and to find out the factors related to the failure of therapy, rebleeding, and survival after the therapy. Patients and methods: Sixtyseven patients who treated with n-butyl 2-cyanoacrylate injection therapy for active (spurting or oozing) or recent hemorrhage (adherent clot or fibrin clot over varices) from gastric varices were retrospectively reviewed. Results: Initial hemostasis, defined as complete control of active bleeding, was achieved in all 12 patients. Success of therapy, defined as absence of rebleeding or death during the 5 days after the therapy, was achieved in 88% of patients. A stepwise logistic regression analysis including age, sex, cause of cirrhosis, Child-Pugh class, variceal form, bleeding site (cardia or fundus), initial hemoglobin and presence of hepatocellular carcinoma as variables indicated that only the Child-Pugh class was an independent predictive factor of treatment failure (Odds ratio, 14.7; 95% CI, 1.69-128.4; <i>P</i>= 0.015). Rebleeding occurred in 13 patients (19%) during 4 weeks after the therapy. The actuarial probability of 4-week remaining free of rebleeding after initial therapy was 77.6% and it was significantly higher in patients with Child-Pugh A and B than in patients with Child-Pugh C (95.1% vs 50%; P=0.0001). Mortality at 4 weeks was 15%. A stepwise logistic regression analysis including the same variables used for failure of therapy indicated that the Child-Pugh class (Odds ratio, 16.8; 95% CI, 1.8- 154.5; P=0.01) and the presence of hepatocellular carcinoma (Odds ratio, 14; 95% CI, 1.5-130.3; <i>P</i>= 0.02) were the independent predictive factors of mortality at 4 weeks. The actuarial probability of survival at 4 weeks after initial therapy was 85.1%. There were 2 cases (2.7%) of major complications due to cyanoacrylate embolism (pulmonary embolism and splenic infarction). However these complications spontaneously resolved and caused no death. Transient fever was found in 10.4% of patients. Conclusion: N-butyl 2-cyanoacrylate injection therapy is highly effective in the management of bleeding from gastric varices. Child-Pugh class is an important predictive factor of treatment failure, rebleeding, and survival after the therapy.

Follow-up of hepatitis C virus RNA in peripheral blood mononuclear cells during interferon therapy.

Mononuclear cells can be infected in vitro by hepatitis C virus and the viral RNA can be detected in mononuclear cells of chronically infected patients. It was suggested that the virus could persist in the mononuclear cells of some patients treated by interferon. The aim of this study was to follow the presence of viral RNA in the plasma and peripheral blood mononuclear cells of 16 chronically infected patients treated by alpha 2b interferon for 1 year. The RNA was detected by reverse transcription followed by nested PCR and quantified using the branched DNA method at regular intervals for at least one year. Before PCR, the mononuclear cells were treated by RNase and trypsin in order to eliminate the viral particles that could be stuck at the cell surface. Six patients were non responders and had persistent plasmatic viral RNA during the treatment. Two patients were good responders and had persistently negative PCR in both plasma and mononuclear cells. Eight patients had initial negativation of plasmatic hepatitis C virus RNA but showed a relapse characterized by positive plasmatic PCR. Positive PCR in mononuclear cells despite negativity of plasmatic PCR was noted 18 times in 8 patients. Persistently positive PCR in mononuclear cells in absence of detectable viraemia was followed by a virological relapse in 5 of these patients. This study confirms that hepatitis C virus RNA can be detected in mononuclear cells despite negative plasmatic PCR in patients treated by interferon. Moreover, the persistence of viral RNA in peripheral mononuclear cells could be a predictive factor of treatment failure. Our data also suggest that detection of viral RNA in mononuclear cells is probably not only due to passive virus adsorption from plasma.