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A novel, simple, sensitive, and precise spectrofluorometric assay of cancer antigen [CA 125] is described. This modality is based on monitoring the quenching of the luminescence intensity at 790 nm of the phthalocyanine fluorophore, in a nanocomposite comprising the fluorophore and cationic polystyrene, which results from interaction with CA 125. The remarkable quenching of the luminescence intensity of the Ni-phthalocyanine complex doped in PS matrix by various concentrations of CA 125 was successfully utilized as an optical sensor for the determination of CA 125 in different serum samples of ovarian disease. The performance of the designed biosensor is determined through monitoring the quenching of the luminescence intensity at 790 nm by cancer antigen 125 after excitation at 685 nm, pH 7.3 in water. The calibration plot was achieved over the concentration range 1.0 × 10−2 – 127 U mL−1 CA-125 with a correlation coefficient of 0.99 and detection limit of 1.0 × 10−4 U mL−1. The mechanism of the interaction between the nano thin film nickel(II)phthalocyanine and CA-125 was discussed. A significant correlation between the proposed method for the assessment of CA 125 and the standard method was applied to patients and controls.

The purpose of this study is to compare the technical success of transjugular intrahepatic portosystemic shunt (TIPS) in transplanted versus nontransplanted livers and to assess the clinical outcome of TIPS in liver transplant recipients.A retrospective audit of patients receiving a TIPS was performed in two institutions during 1996-2009. The technical success of the TIPS was compared for transplanted versus nontransplanted livers. Clinical success was defined as graft survival longer than 1 month with improvement in symptoms. The cohort was divided into grafts that survived less than 3 months versus 3 months or more. The model for end-stage liver disease (MELD) scores and portosystemic gradients before and after TIPS creation were evaluated for predictive value for graft survival. The TIPS stent type, MELD scores and portosystemic gradients before and after TIPS creation, and causes of liver disease were evaluated for their predictive value for ascites response after TIPS creation.Thirty-nine TIPS in transplanted livers were found, representing 5.5% (39/715) of all TIPS procedures performed and 2.0% (39/1992) of all liver transplant recipients. Ninety percent of TIPS in transplanted livers had ascites. The median time from transplant to creation of the TIPS was 29 months (2-127 months). The median MELD score was 16 before and 22 after the TIPS procedure. The technical success rates for TIPS were 97% (38/39) in transplanted livers versus 97% (657/676) in nontransplanted livers (p = 1.00). Intent-to-treat clinical success rates were 36% for all indications versus 31% for ascites only. There were no predictors for ascites response. Six-, 12-, and 24-month graft survival rates were 43%, 32%, and 22%, respectively. One-year graft survival for a MELD score less than 17 versus a score of 17 or higher was 54% versus 8%, respectively (p0.05).Transplantation does not pose a technical challenge to TIPS creation. One third of patients have a favorable outcome. MELD score is the only predictor of graft survival.

Purpose To evaluate the feasibility of establishing a U-shaped inferior vena cava (IVC) catheter entirely from a transhepatic approach and to determine the catheter caliber that would provide adequate flow for hemodialysis. Materials and Methods Three pigs (weight, 45–50 kg) were used. A peripheral right hepatic vein was accessed transhepatically by using a 22-gauge needle, and a 0.018-inch wire was passed into the hepatic veins and IVC. An accessory right hepatic vein was accessed from the IVC. A snare was deployed in the accessory vein and used as a target for a second transhepatic 22-gauge needle pass. A wire was snared through the second transhepatic tract, around into the IVC, and through the first transhepatic tract. The 0.018-inch wire was upsized to a 0.035-inch platform. Measurements where made to tailor a U-shaped catheter from simple 10.2- and 12-F tubes by cutting them longitudinally (single long side hole) along the length of the IVC segment. The U-shaped hemodialysis catheter was placed over the wire and positioned so that the catheter opening lay in the IVC. With use of a dialysis machine, pressures and flow tolerance at set flow rates (100, 200, 300, 350, and 400 mL/min) were tested. Results All pigs underwent and survived successful catheter placements. All 10.2- and 12-F catheters tolerated flow rates up to 350 and 400 mL/min, respectively. Conclusions Establishing a U-shaped hemodialysis catheter with an entirely transhepatic approach is technically feasible. The 10.2-F U-shaped dialysis catheters provided a flow rate (>350 mL/min) that is appropriate for hemodialysis in human clinical settings.

To determine the effectiveness of augmenting T-tube cholangiography by using intravenous morphine in orthotopic liver transplant recipients with choledocho-choledochostomies and poor filling of intrahepatic biliary ducts and to determine factors that may increase the likelihood of nonfilling of intrahepatic ducts.A retrospective review of T-tube cholangiograms obtained in orthotopic liver transplant recipients was performed. Intravenous morphine had been given by two of five operators to augment T-tube cholangiograms with poor filling of bile ducts. Patients with malpositioned tubes and decompressive bile leaks were excluded from morphine diagnostic efficacy evaluation but were included in the overall cholangiogram diagnostic yield. Anastomotic narrowing, if present, was graded as follows:50%, 20%-50%, and20% diameter reduction. Patients with intrahepatic bile duct filling were compared to those without filling with regard to age, sex, time from transplantation, and clinically significant (50%) stenoses.One hundred sixty-eight cholangiograms were obtained in 127 recipients. Twenty-three of the 168 cholangiograms (13.7%) had malpositioned/blocked T-tubes and five (3%) had decompressive leaks; 140 cholangiograms had well-positioned tubes and no leaks. Twenty-two of the 140 cholangiograms with well-positioned tubes and no leaks (15.7%) had nonfilling of peripheral bile ducts. Morphine (range, 2-6 mg; mean, 4 mg) had been used in 13 cases. Adequate filling after morphine was noted in 12 of the 13 cases (92%), and no complications occurred. Morphine improved adequate diagnostic examination of well-positioned patent T-tubes from 85% (123/145) to 93% (135/145). No parameters helped predict inadequate filling in well-positioned tubes (P.05).In 92% of cases, intravenous morphine was successful in opacifying the biliary tract without complications. In well-positioned T-tubes, the use of morphine increased diagnostic yield from 85% to 93%. No predictors for inadequate filling were found.

To determine the effectiveness of transjugular intrahepatic portosystemic shunt (TIPS) creation in liver transplant recipients with recurrent portal hypertension presenting with refractory ascites.A retrospective review of transplant recipients undergoing TIPS creation was performed over a 6-year period. Recipients were noted for age, sex, TIPS indication, Model for End-stage Liver Disease (MELD) score, cause of initial liver disease, and time between first transplantation and TIPS creation. Clinical success was defined as graft survival of longer than 1 month with improvement in ascites. New-onset or worsening encephalopathy was noted. Graft survival and patency were calculated according to the Kaplan-Meier method. MELD score and portosystemic gradient (PSG) before and after TIPS creation were evaluated for prediction of graft loss less than 3 months after TIPS creation.Nineteen liver transplant recipients underwent TIPS creation for ascites. Mean time from transplantation was 3.5 years (range, 3.7-112.2 months). Mean MELD score before TIPS creation was 17 (range, 7-24). The technical, hemodynamic, and clinical success rates were 100%, 95%, and 16%, respectively. Encephalopathy developed in five patients (26%). Thirty- and 90-day mortality rates were 16% (n = 3) and 21% (n = 4), respectively. Primary unassisted patency and graft survival rates at 1, 3, and 6 months were 100%, 90%, and 90% and 79%, 58%, and 47%, respectively. MELD score parameters were significant indicators (P.05) for graft survival beyond 3 months, but PSG parameters were not.TIPS for the management of ascites in liver transplant recipients is not as clinically effective as it is in patients with native livers (16% vs 50%-80% in the literature). MELD score is a predictor of graft survival; PSG parameters are not.

Purpose To assess the synergistic effect (benefit), if any, of combining TIPS and BRTO for the management of gastric variceal (GV) bleeding. The hypothesis being that TIPS compensates for the closure of the gastrorenal shunt (a spontaneous portosystemic shunt) during the BRTO procedure. Materials and Methods A retrospective audit of patients undergoing BRTO for the management of GV bleeding was performed (2007-2012) in 8 centers in the United States. The cohort was divided into patients that underwent BRTO only and those that underwent BRTO with coexisting TIPS (BRTO+TIPS group). The BRTO+TIPS group was subdivided to concomitant TIPS (TIPS created within 2 weeks from the BRTO) and prior TIPS (>2 weeks prior to the BRTO). Demographic comparisons were made between the groups. Kaplan-Meier method was used for rebleed and survival rates (comparisons were by Log-Rank test). Results 100 patients underwent BRTO only and 18 patients underwent BRTO with a coexisting TIPS. The technical and GV obliterative rate for BRTO+TIPS compared to BRTO only was 100% (n=18/18) and 100% (n=18/18) compared to 91% (n=94/103) and 80% (n=80/100), respectively (p=0.039). The complication rate and 30-day mortality for BRTO+TIPS compared to BRTO only was 6% (n=1/18) and 11% (n=2/18) compared to 2% (n=2/103) and 5% (n=5/100), respectively (p=0.3 to 0.4). The long-term outcomes of successful procedures are shown in the table. Conclusion Despite the trend of reduced rebleeding and the occurrence clinically significant ascites in patients undergoing BRTO with coexisting TIPS compared with BRTO-only, TIPS adds no significant value to the BRTO procedure. Patients with prior TIPS have a better survival than patients who undergo a combined BRTO and TIPS procedure. Table 1

Purpose To evaluate the technical, hemodynamic and clinical outcomes of BRTO utilizing 3%STS for gastric variceal (GV) bleeding. Materials and Methods A retrospective audit of patients undergoing BRTO only (coexisting TIPS excluded) for the management of GV bleeding was performed (2007-2012) in 8 centers in the United States. Cox proportional hazard was used to evaluate for risk factors for survival (institution, age, gender, etiology, HCC, ascites levels, GV bleeding status and MELD-score). Kaplan-Meier method was used for rebleed and survival rates (comparisons were by the Log-Rank test). Results 100 patients underwent 103 BRTO procedures with a technical and intent-to-treat complete GV obliteration rate of 91% (n=95/103) and 80% (n=80/100), respectively. 18 patients were actively-bleeding, 68 had prior-bleeds and 14 had impending-bleeding. Complication rate, procedure related mortality and 90-day mortality was 12%, 2% and 6%, respectively. Liver failure leading to death or liver transplantation within 90-days was 7% (4% death and 3% transplant). MELD>13 (p Conclusion BRTO utilizing 3%STS foam is safe and effective. Poor outcome is associated with HCC and a MELD>13 at the time of procedure. BRTO is effective in emergently controlling active bleeding (94%), however, elective BRTO has better survival. Table 1