message from the past: splenectomy and devascularisation with salvage sclerotherapy in the treatment of bleeding schistosomal oesophageal varices

To study the short and long term results of splenectomy and esophagogastric devascularisation in the prevention of bleeding from esophageal varices secondary to schistosomal portal hypertension. This is a retrospective prospective study of patients, who underwent splenectomy and devascularisation for schistosomal bleeding varices during the period 1980 to 1990 at Soba university hospital. They had clinical, laboratory, and endoscopic evaluation. They were followed up for a period of 10 years [mean 4.5 years]. At follow up special emphasis was laid on recurrence of variceal hemorrhage and, or mortality. Patients with recurrent variceal bleeding received emergency treatment in the form of resuscitation, balloon tamponade when necessary, and flexible endoscopic sclerotherapy. Splenectomy and oesophagogastric devascularisation was performed in 185 patients, and devascularisation only in 5 patients. Early postoperative mortality occurred in 8 patients [4.2%]. Early recurrence of variceal bleeding occurred in 4 patients who responded to emergency treatment. Transient of treatable ascitis developed in 21% of patients, transient jaundice in 12.6%, and liver failure in 1.6%. Major postoperative septic complications occurred in 6.4%. The rate of recurrence of variceal bleeding was 18.1% within the first 5 years, and 23.6% by 10 years follow-up. Late mortality occurred in 8 patients [4.4%]. The overall mortality of the procedure was 8.4%. Splenectomy and oesophagogastric devascularisation for the treatment of schistosomal portal hypertension can be associated with a high rate of variceal rebleeding. However, when coupled with sclerotherapy for recurrence, it carries an acceptable mortality rate

Pattern of primary nocturnal enuresis in primary school children (first grade) in assiut city

Objectives :To assess the prevalence of nocturnal enuresis in primary school children; first grade (6-7 years old) in Assiut City and study its pattern and risk factors. Patients and Methods: A random cross-sectional study including 1519 children was conducted in 10 primary schools in Assiut City throughout a period of six months. A self-administered questionnaire was completed voluntarily by the parents. Children reporting two or more incidences of nocturnal enuresis per month during the past year were considered positive repliers and were subjected to further evaluation. The control group consisting of 100 age-matched non-enuretic children presenting for other urologic or non-urologic problems mandating a plain abdominal X-ray was subjected to the same evaluation. In these children the possible detection of spina bifida was the point of concern. Results: The response rate to the questionnaire was 79. The prevalence of enuresis was 20.2. Out of the enuretic children; 87.6complained of nocturnal enuresis only; 72.3of them were primary enuretics. Monosymptomatic enuresis was observed in 46.3of the cases. Marked enuresis (every night) affected 53.7of the total number of enuretic children. Statistically significant risk factors were deep sleep and a high educational level of the parents. Primary nocturnal enuresis was insignificantly associated with a positive family history; family size or birth rank. In primary nocturnal enuretics the results of the urogenital and neurological examinations were normal in 90.5and 80.6; respectively; and only 4received a specific treatment. A large amount of post-void residual urine was observed in 7.4. Spina bifida occulta was observed in 10.8of primary nocturnal enuretics and in 11 of the control group. Conclusions: This is the first large population-based study of the prevalence of age-related enuresis in Assiut; but it does not differ much from those reported in other parts of the world. Enuretic children and their parents are mildly concerned about enuresis. Investigations for monosymptomatic primary nocturnal enuresis are not of considerable diagnostic value or cost effectiveness