Effects of trunkal vagotomy and drainage upon helicobacter gastritis

This study was carried in the Surgical Department of Kasr El-Aini University Hospital over a period extending from November 1995 through December 1998. Twenty patients suffering from chronic duodenal ulccration, 14 males and 6 females, with a mean age of 38.8 years, who presented for surgery, were included in the study. The indications for surgery constituted failure of long term medical treatment [12 cases], complications [4 cases], frequent relapses [2 cases]. Pre-operative endoscopic biopsy from the gastric antrum revealed positive H.pylori infestations in all cases. 3 months following trunkaI vagotomy and gastroentcrostomy, re-endoscopy revealed healing of the ulcers in all cases. Biopsies obtained from within one inch of the gasto-enterostomy revealed however, persistence of H. pylori in 40% [8] of cases

Management of the pancreatic stump following pancreaticoduodenectomy: Experience with thirty five cases

Thirty five patients underwent pancreaticoduodenal resection for: carcinoma of the lower end of the common bile duct [n= 12] and carcinoma of the lower end of the common bile duct [n= 20], pancreatic stump was death with in three ways: pancreatico-jejunostomy [n= 20], pancreaticogastrostomy [n=5]. The overall operative mortality was 11% [n= 4]. Pancreatic fistulae accounted for two of these deaths [50%] being the major cause of operative mortality in this series. Five cases, among the 30 patients who had pancreaticoenteric anastomosis, developed pancreatic fistulae [16%]. The complication was fatal in two of them [40%]. The incidence was higher following pancreaticojejunostomy [20%] compared to pancreatico-gastrostomy [10%]. The outcome of the fistulae was also different with two mortalities in the pancreaticojejunostomy group and spontaneous closure in the remaining two while the only fistula following pancreaticogastrostomy closed spontaneously. Among those who had total pancreatectomy [n= 5] there was one operative mortality due to hemorrhage are late mortality related of difficulty in control of diabetes

effect of oral aspirin on the intra-operative bleeding: a prospective clinico-haemotologic double-blind controlled trial

In this trial, the effect of prophylactic low dose of aspirin on the intraoperative and postoperative bleeding was assessed in twenty five patients who received preoperative low dose of aspirin compared with another twenty five patients who received vitamin B-complex as a placebo. All the fifty patients were subjected to tests of haemostatic function before and 24 hours after receiving the drug. All were operated upon with standardization of the surgical procedure. The results of the study showed a definite increase in intraoperative blood loss associated with intake of low dose of aspirin. This increased loss could be attributed to the decreased platelet thromboxane A2 production resulting in defective platelet aggregation. So, it seems advisable to stop intake of aspirin at low doses before operations. The interval between aspirin cessation and surgery would depend upon the duration of action which would correspond to the life span of platelets due to the permanence of its effect i.e. approximately 10 days