Early surgery reduces mortality in major bleeding from chronic peptic ulcers

Comparing the results in the management of cases of major hemorrhage from chronic peptic ulcers in two periods of time, the retrospective [group A] from December 1986 to August 1989 when reluctant and late surgical intervention was the policy followed and the prospective [group B] from September 1989 to February 1992 adopting the policy of early surgical intervention [less than 11 hours] if the patient has one or more of the following criteria: Major hemorrhage above the age of 50 years, endoscopic major stigmata of recent hemorrhage, clinical evidence of further hemorrhage, showed that early diagnosis and early surgical intervention significantly improved the mortality rates and significantly decreased the amount of blood transfusion needed in these cases

Problems encountered in diagnosis and management of retroperitoneal cystic swellings

This study included 7 patients with retroperitoneal cysts who were diagnosed and managed between 1989 and 1992. All cases presented with intra-abdominal masses and 5 patients had pressure symptoms of either the gastrointestinal or the urinary tract. The initial diagnosis of an intra-abdominal cyst was made by ultrasound in 6 cases. CT scan was reliable in the diagnosis of a retroperitoneal cyst in all the cases as well as demonstrating its anatomic relations. Diagnostic aspiration of the cyst is a potentially hazardous procedure and should not be done. Five patients had complete excision of the cyst and 2 patients had excision by marsupialization. Complete excision of the cyst remains the treatment of choice. Marsupialization can be undertaken in cases of developmental cysts when complete excision can not be safely done if frozen section histology proves benign nature of the cyst

Three-years experience in the management of bleeding oesophageal varices

The experience in the management of bleeding esophageal varices over a period of three years according to a management protocol for the treatment of these cases initiated in January 1988, is presented in this study. This study included 840 patients, 613 were males and 227 were females. Minimal follow up of these cases was 18 months. Early endoscopic injection sclerotherapy successfully controlled the bleeding in 479 patients [57%], Linton Nachlas tube was fixed in cases of severe hemorrhage or if failure of injection sclerotherapy and a second trial of injection sclerotherapy, while the tube was in place successfully controlled the bleeding in another 209 patients. Thus, achieving control of acute bleeding in 87.7% of all patients. Surgical treatment was only done for patients having child A or B state. Emergency Hassab's operation was done in 28 patients, achieving a cumulative 18 months successful outcome in [53.6%]. Elective Hassab's operation was done in 225 patients giving 18 months success rate of 88%. All C patients were treated nonoperatively. Those with persistent hemorrhage [72 cases] were treated with terlipressin or octreotide while those who stopped bleeding were treated with repeated endoscopic sclerotherapy. The overall mortality after 18 months was 40%

Endoscopic therapy of actively bleeding peptic ulcers

This is a prospective randomized controlled study comprising 64 patients presenting with bleeding peptic ulcers to the accident and emergency department Ain Shams University Soecialized Hospital randomized to either endoscopic injection using adrenaline 1:10000 or conservative treatment. Only high risk patients with active bleeding or visible in the floor of the ulcer were considered. The two groups were well matched for age, shock hemoglobin concentration, endoscopic findings and consumption of non-steroidal anti-inflammatory drugs. The group treated endoscopically had a significantly reduced rebleeding rate with a lower operation rate and lower blood transfusion requirement our results suggest that adrenaline injection therapy which is a simple technique should be considered as the initial line of treatment of choice in bleeding peptic ulcers

Prenatal diagnosis of fetal intestinal obstruction

Five cases of intrauterine fetal intestinal obstruction were encountered during routine obstetrical ultrasonic scanning of 2400 pregnalit women over a period of 26 months. Diagnosis had been confirmed by plain x-ray bdomen after birth. Laparotomy and proper reconstructive surgery was done for all the five cases in the first few hours of the infants life. All of them showed minimal post operative complications and short hospital stay. Follow-up was done for 6 months or more, and all of them were thriving