Splenectomy and devascularization versus injection sclerotherapy in management of bleeding oesophageal varices

In this study 40 patients with bleeding oesophageal varices were randomly divided into two groups: group [I] [included 25 patients and group [II] included 15 patients. All patients fulfilled the criteria of A Child's classification. Group [I] patients were subjected to injection sclerotherapy and those of group [II] were subjected to splenectomy and devascularization. All the patients were followed up for a period ranging from 6 to 20 months. In group [I] complete disappearance or fibrosis of the varices was achieved in 76% and reduction of the varices size in 20%, but in 4% there was no significant change. In group [II] complete disappearance or fibrosis of varices was not reached but reduction of the varices occurred in 60%. Recurrent bleeding occurred in 28% in group [I] in comparison to 40% in group [II]. Mortality in group [I] was 8% while in group [II] it was 13.4%. these results indicate that injection sclerotherapy is an affective modality of treatment of oesophageal varices with less complications than splenectomy and devascularization

Diagnosis of obscure ascites, evaluation of the diagnostic importance of laparoscopy, Ultrasonography and abdominal paracentesis

In an attempt to demonsrtate the diagnostic work up of obscure ascites and to evaluate the role of different diagnostic techniques especially abdominal paracentesis, abdominal ultrasonography and laparoscopy with guided biopsy, fifteen patients with obscure ascites were studied. Careful history, thorough clinical examination, laboratory investigations, ascitic fluid examination and abdominal ultrasonography were performed for every patient. Thereafter, laparoscopic examination was conducted in all cases. Under visual control, biopsies were taken from visible lesions and suspecious areas for histopotholoical examination. Finally causes of ascites in those patients were found as follows malignant liver [5 cases], tuberculous peritonitis in association with a chronic liver disease [5 cases], tuberculous peritonitis alone [1 case] and chronic liver disease alone [4 cases]. Laparoscopy proved superior to all diagnostic techniques used. It provided clear visualization and directed biopsy of intraabdominal organs by which a definite diagnosis was established in all cases. We were impressed with its safety and the ease with which our patients tolerated the procedure. Also this study revealed the importance of association of tuberculous peritonitis with chronic liver disease

Idiopathic entrapment of the lateral popliteal nerve

Five patients with idiopathic entrapment of the lateral popliteal nerve are presented. Three of them underwent electrophysiological examination and had delayed conduction in the lateral popliteal nerve. All the patients were operated upon for release of the nerve at the level of the neck of the fibula, with immediate postoperative relief. This entity is an important differential diagnosis for disc lesion with root entrapment

Fibronectin as a parameter in diagnosis of ascites

The aim of this work was to estimate the fibronectin level in ascetic fluid and to evaluate its role in discrimination between malignant and non malignant ascites. Thirty two cases, classified into malignant and non malignant ascetic patients, in two equal groups, were chosen for this study. Radial inumunodiffusion, as a simple, rapid and reliable method was used to determine the fibronectin level in the ascetic fluid. The fibronectin concentration, was markedly and significantly increased in the malignant than non malignant ascites. From the present study it might be concluded that fibronectin, which is formerly reported to have a well established relation with malignancy, must be considered as a significant tumour marker in the aetiological diagnosis of ascites. Frequent regular estimation of fibronectin level in the ascitic fluid is recommended in patients with cirrhotic liver to detect the onset of malignant transformation as early as possible, and in patients with malignancy to evaluate its prognosis