Copmarison between Endoscopic band ligation and Sclerotheraby in management of upper Gastro-intestinal hemorrhage due to esophageal varices

Upper gastrointestinal bleeding is serious complication of portal hypertension which can be treated by different medical and surgical methods with possibility of failure, re-bleeding and death. Objective: To evaluate the efficacy of band ligation and Sclerotherapy in controlling initial bleeding, failure of control [during first 24 hours] and re-bleeding within 5 days. Patients and Methods: This prospective study was conducted at Gastroenterology and Hepatology Teaching Hospital in Medical city complex in Baghdad from the 1st of January 2010 to the 1st of March 2012. The study engaged 100 consecutive patients who were divided equally into two groups [50 patients each], first group were treated with banding procedure while patients in second group were treated with sclerotherapy and both groups were followed up for 5 days. Results: Neither failure to control bleeding [during first 24 hours] nor death occurred in both groups. Successfulness [no re-bleeding within 5 days] was more common in Band ligation group [94%] rather than sclerotherapy group [90%]. On the other hand, 8 patients in both groups all were child-pugh C developed re-bleeding, 3 patients [6%] in Band group and 5 patients [10%] in sclerotherapy group and need second session which was successful in all patients in both procedures, comparison statistically was significant and Band procedure was better than Sclerotherapy procedure, [P. value=0.029]. Conclusion: Endoscopic Band ligation is more effective than Sclerotherapy in controlling initial attacks of esophageal varices bleeding and decreasing recurrent attacks of bleeding

Sandflies (Diptera: Psychodidae) in a focus of visceral leishmaniasis in White Nile, Sudan

Visceral leishmaniasis (VL) has been known to occur since the 1980s on the western bank of the White Nile River (Central Sudan), 150 km south of Khartoum, and has resulted in high mortality. The most recent outbreak of the disease in this area began in 2006. Entomological surveys were carried out during May 2008, June 2010 and May and July 2011 in the White Nile area. Sandflies were collected using Centers for Disease Control light traps and sticky oil traps in the village of Kadaba and the nearby woodland. Phlebotomus females were dissected for the presence of Leishmania promastigotes. A total of 17,387 sandflies, including six species of Phlebotomus and 10 species of Sergentomyia, were identified. The Phlebotomus species recorded were Phlebotomus orientalis, Phlebotomus papatasi, Phlebotomus bergeroti, Phlebotomus duboscqi, Phlebotomus rodhaini and Phlebotomus saevus. P. orientalis was collected in both habitats. The relative abundance of P. orientalis in the woodland habitat was higher than that recorded in the village habitat. In the woodland habitat, there was a notable increase in the relative abundance of P. orientalis during the surveys conducted in 2008 and 2010 compared to 2011. None of the 311 P. orientalis females dissected were infected with Leishmania promastigotes, although relatively high parous rates were recorded in both habitats. Based on the distribution of P. orientalis recorded in this study, this species is the most likely vector of VL in the endemic focus in the White Nile area. Further investigation is required to elucidate the seasonal abundance and distribution of the vector, as well as the transmission season of VL in both habitats so that appropriate control strategies for the vector can be designed.

study of the histochemical alterations of mucin in cases of cholelithiasis and gall bladder tumors

To investigate the alterations in these oligosaccharide side chains in gall bladder epithelial cells by histochemical techniques to shed further light in elucidating the development of gall stones and gall bladder neoplasia. The study was conducted on 35 cholecystectomies performed over a period of 3 months started from September[1st] 2008 to December[1st] 2008 in the laparoscopic unit in Al-Jomhori Teaching hospital in western side of Mosul city in northern Iraq. Clinical details and pathological data were retrieved from the records. The cholecystectomy specimens that were received were fixed in 10% formalin. The gall bladders were classified into two groups [calculus and acalculus]. Multiple sections were taken from each gall bladder [body, neck, and fundus] for paraffin blocks and were examined after staining with hematoxylin and eosin [H and E] in the Laboratory of Postgraduate Studies at the Department of Anatomy, Histology and Embryology in Mosul College of Medicine. Microscopic examination was done to assess the type of different lesions including inflammatory infiltrate, presence of fibrosis, cholesterolosis, metaplasia, dysplasia, tumor or tumor-like lesion. To evaluate the intra-epithelial mucin content multiple sections were processed and stained with Alcian blue [AB] /Periodic acid Schiff's stain [PAS]. The histochemical analysis of mucin of the sections which showed normal gallbladder mucosa revealed that most of the cells of normal gallbladder epithelium exhibiting positive PAS reaction indicating the presence of neutral mucins, while the acidic mucins showed weak reaction by alcian blue but brown color staining were not observed indicating the absence of sulfomucins. Histochemical analysis of mucin of the stone-containing gallbladder epithelium which showed different histological findings including inflammatory infiltrate, presence of fibrosis, cholesterolosis, and Rokitansky-Aschoff sinuses, revealed that the intense blue staining of sialomucins along with the very weak staining intensity of neutral mucins in goblet cells was observed by PAS-AB at pH 2.5 with strong intensity of Sulfomucins with as shown by the brown staining of alcian blue at pH 1.0. Histochemical alteration of mucin in the cases of adenoma of the gall bladder revealed that the intense blue staining of sialomucins with the weak staining intensity of neutral mucins in goblet cells was observed by PAS-AB at pH 2.5 with strong reaction of sulfomucins. On the other hand, intense blue staining of sialomucins along with the moderate staining intensity of neutral mucins was observed in section which showed dysplastic changes and in those which was diagnosed as carcinoma of the gall bladder. This study concluded that the sulfomucins and then the sialomucins may have a greater role in gall stone formation than the neutral mucins

Retrograde approach to the facial nerve in parotid gland surgery

The temporal branch of the facial nerve was examined in 8 cadaver dissections [4 right and 4 left]. A number of rami crossing the zygomatic arch and their location with respect to bone and soft-tissue landmarks were estimated. The temporal branch course follows a constant plane along the under surface of the temporoparietal fascia and it was found to be superficial as it crosses the zygomatic arch. Based on these relationships, a safe method of dissection within the temporal region was formulated. In five cases with retromandibular parotid neoplasms, the seventh cranial nerve was located through a retrograde exploration of its temporal branch. The decision to resort to the identification of the temporal branch is supported by its adequate calibre in its peripheral area, short course, and multiple rami crossing the zygomatic arch, which enable it to be easily located. Retrograde or centripetal approach to facial nerve has been found to be anatomically sound, simple to use and safe. It must be indicated when anterograde exploration is difficult

Retrograde approach to the facial nerve in parotid surgery

The temporal branch of the facial nerve was examined in eight cadaver dissections. Number of rami crossing the zygomatic arch and their location with respect to bone and soft-tissue landmarks were estimated. The temporal branch travelled in a constant plane along the under surface of the temporoparietal fascia and was superficial as it crossed the zygomatic arch. Based on these relationships, a safe method of dissection within the temporal region was formulated. In five cases with retromandibular parotid neoplasms, the seventh cranial nerve was located through retrograde exploration of its temporal branch. The decision to resort to the identification of the temporal branch is supported by its adequate calibre in its peripheral area, short course, and multiple rami crossing the zygomatic arch, which enable it to be easily located. Retrograde or centripetal approach to facial nerve has been found to be anatomically sound, simple to use and safe. It must be indicated when anterograde exploration is difficult