Cervical lympho-venous shunt versus denver shunt in management of intractable ascites [analysis of 170 cases]

The present study was conducted on 170 patients with intractable ascites secondary to liver cirrhosis. The present study showed that both peritoneo-venous and lympho-venous shunts are technically simple procedures that could be done under local anesthesia in nearly similar time duration. However, Denver shunt is expensive, it costs between LE 4000-6000. Lympho-venous shunt is a biological cheap procedure. It can be concluded from this study that patients with intractable ascites could be offered surgical therapy with either shunts with a high success rate. Cervical lympho-venous shunt appears to be a simple, safe, cheap and effective method for achieving a long-term control of refractory ascites. The use of a biological shunt is an added advantage over prosthetic shunts for drainage of ascetic fluid with almost negligible complications. Failure does not interfere with the future use of the expensive peritoneo-venous Denver shunt. Denver peritoneo-venous shunt is a good device to relieve ascites, thereby reducing the risk of complications and the number of hospital admissions due to repeated paracentesis and consequently improving the quality of life. However, its high cost limits its wide scale application. A careful patient selection is mandatory for optimal results

role of magnesium in the etiology of paralytic ileus

Serum magnesium, calcium, sodium, potassium and urea were studied in 60 patients comprising 3 groups of 20 patients each. The first group included patients subjected to abdominal surgery and in whom the bowel sounds were delayed for more than 72 hours, with no passage of flatus or stools. The second group were also post-abdominal operation patients, but who restored the bowel function within 3 days. The third group were rather healthy volunteers. The levels of serum magnesium were lower in both postoperative groups, comparing with the control, but the differences were statistically insignificant. Similarly, there were no significant differences in the levels of serum calcium, sodium and urea between the 3 groups. On the other hand, the serum potassium levels were significantly lower in the ileus groups, when compared with the non-ileus postoperative cases or with the control [P <0.05]

Sonography-guided paracentesis abdominis in acute abdomen

Out of 429 patients diagnosed as acute abdomen in the Casualty Section at Shibin El-Kom and Kasr El-Aini hospitals during 6 months, 30 patients were selected at random for the study, and 30 patients were used as control. They were studied both clinically, and by ultrasonography-guided abdominal paracentesis. When negative results were obtained by paracentesis, peritoneal lavage was done. The technique of paracentesis is described. Among the 30 cases of the series 12 were males and 14 females and four children. Their age ranged from 1.5 to 70 years. In seven cases a mass was felt in the abdomen and in five cases history of recent trauma was present. Four cases had a history of previous surgery and a history of peptic ulcer was present in one case. At operation the final diagnosis was peritonitis in 7 cases, intestinal obstruction in 6 cases, acute cholecystitis in 4 cases and trauma in 3 cases and miscelaneous conditions in the remaining 10 cases. The diagnostic yield of abdominal paracentesis in the series is 100% and it had the additional value of suspecting the cause of peritonitis, differentiating between appendicular mass and abscess and in avoiding operation for pancreatitis. Following trauma it was valuable in deciding early operation. It is inadvisable in amoebic liver abscess and should be avoided in intestinal obstruction

Cervical lymphovenous shunt in treatment of intractable ascites

This study was carried out for 50 patients suffering from intractable ascites secondary to bilharzial periportal fibrosis. The patients were divided into two groups, the first group included ten patients, they were hospitalized and subjected to medical treatment. The second group included 40 patients with intractable ascites. For these patients surgical treatment was carried out in the form of cervical lymphovenous shunt. Patients who were treated surgically have got a satisfactory improvement as regards activity and respiration. The ascites disappeared compIetely in 10 patients [25% of cases], in the rest of the patients the ascits decreased to a state that was comfortable to the patient and clinically evident. Patients under medical control did not gain the same satisfactory results. The results were compared with the results of treatment of 6 patients with intractable ascies by Leveen shunt. It was concluded that cervical lymphovenous shunt for treatment of ascites secondary to bilharzial periportal fibrosis proved to be a safe, satisfactory simple procedure with almost negligible complications

relationship between typhoid carrier state and hepatobiliary cancer in Egypt: a preliminary report

Hepatobiliary cancer [especially hepatoma] is on rise all over the world as well as in Egypt. A higher incidence of such tumours was found amongst registered typhoid carriers in New York amounting to 5-9% proved by autopsies. Similar findings were reported in Norway and california. We studied the incidence of typhoid carrier status in 30 patients [21 with hepatoma, 4 with hepatic cholongiocarcinoma, and 5 with gall bladder adenocarcinoma] getting a 13.3% incidence compared to a 0% among thirty controls

Kasr el-Aini tube in stricture esophagus malignant

38 cases of malignant stricture of oesopagus were studied, out of whom 25 had squamous cell carcinoma. Their age ranged between 50-82 years. They all presented with distressing dysphagia. 3 had bronchooesophageal fistula following radiotherapy. They were intubated using a locally manufactured [Kasr El Aini] tube, put by traction method via abdominal incision and a gastrostomy. 11 were done under local anaesthesia and the rest under careful general anaesthesia. No operative mortalities were met with. The post-intubation result was very satisfactory with cure of their dysphagia in all and a 7.8% survival for more than 10 months. Combined bleomycin [chemotherapy] and radical 6.000 reds [radiotherapy] was employed in 10 cases of squamous cell cancer. 5-fluoro-uracil and vincristine or vinblastines were administered in 7 cases with adenocarcioma. It is concluded that palliative intubation with chemo and or radiotherapy is the best line for managing a carcinoma of the oesophagus