Q-TC interval variations after portal decompression with different shunt operations in hepato-splenic schistosomiasis

1: 23 patients of hepato-splenic bilharziasis with history of ruptured oesophago-gastric varices belonging to child's classification A. were subjected to portal decompression by shunt operations comprising 5 patients for interposition mesocaval shunt and 18 for distal Lieno-renal. 2. Pre-operative biochemical, hematologic, electrolytes, radiology, endoscopic E.C.G. and pathology studies as well as percutaneous trans-splenic portal manometry were carried out for them. 3. Post-operative biochemical and E.C.G. assessement were done for all patients. Follow up portal manometry for patients subjected to mesocaval operation and endoscopic assessement of the varices for patients subjected to Warren's operation were done to evaluate portal decompression. 4. An important comparative follow up E.C.G. finding was progressive significant shortening of Q-1c interval 3 and 6 months after Warren's, but not mesocaval operations, the causes of which were discussed. 5. Such finding can offer valuable achievement as regard assessment of emodynamic efficacy of the type of shunt concerning portal decompression portal perfusion, a non-invasive E.C.G. follow up tool to evaluate persistance of shunt patency and finally a possible indicator for shunt occlusion

Reversion of oesophageal acid perfusion test results after paracentesis abdominis in ascitic cases of bilharzial hepatic fibrosis

Twenty six patients with hepatosplemc schistosomiasis and tense ascites, having positive acid perfusion test results, were the candidates of this research. All cases were investigated for brtharzlal aetiology, portal pressure manometry, ascitic fluid volume and pressure estimation and oesophageal acid perfusion test were done before and 10 days after slow paracentesis abdominis. The following results were found: 1. Positive correlation between portal and ascitic fluid pressures before and after paracentesis. 2. Both portal and ascitic fluid pressures were significantly reduced after tapping in all patients. 3. The oesophageal acid perfusion test turned negative in 61.53% of patients 10 days after tapping. 4. The degree of portal and ascitic fluid pressure reduction was more significant in the group showed reversion of oesophageal acid perfusion test. 5. While test reversibility was linked to the portal hypotensive effect of tapping, non reversibility was indicative of inefficient non significant tapping. We can conclude from this work the great value of this simple test in indicating and evaluating the success of tapping in lowering the portal and ascitic fluid pressures in bilharzial ascitic patients