Correlation between antroduodenal enterochromaffin cells, plasma serotonin [5-HT] and histopathological findings in patients with hepatosplenic bilharziasis and upper gastrointestinal bleeding

A correlative clinical, endoscopic, histopathological, histochemical and plasma 5-HT level study was done in 25 patients with hepatosplenic billharziasis recovered from upper gastrointestinal bleeding and 10 controls.Significant hyperplasia and hyperactivity of enterochromaffin [EC] cells in the gastroduodenal mucosa was found in all patients associated with significant increase in plasma serotonin [5-HT] level.This detected hyperserotoninaemia can be attributed not only to the defective hepatic degradation but also to over production by hyperplastic and hyperactive EC-cells. Increased plasma 5-HT level may have a double share in the causation of upper gastrointestinal bleeding by elevation of the portal blood pressure and the induction or gastroduodenal erosions found in patients with hepatosplenic bilharziasis

Malignant body cavity effusion: cytologic criteria with special reference to Ag-nors

This study was conducted on 563 cases of body cavity effusions to establish the following points: 1. Determination of the underlying malignant causes 2. A search for the morphological feature of malignant cells for determination of their nature and site of origin 3. Differentiation between mesothelioma, cells and metastatic adenocarcinoma. Also, differentiation between non - Hosgkin's lymphoma and non- neoplastic lymphoid reaction.Qualitative cytoplasmic feature of prepared smears were studied by May- Grueniwald Giemsa [MGG] and nuclear feature in slides stained by Papanicolaou's stain [PAP]PAS stain and AB stain were used when needed 100 cells were assessed. Malignant effusions constituted 17.23% of all studied cases metaststic carcinoma was found to be the most common cause of pleural and peritoneal effusions.Adenocarcinomas formed the majority and the different primarysite of origin were breast, lung GIT and ovaries. Lymphoma/leukemia constituted the second frequent cause of body cavity effusions. It has been shown that MGG stain is highly valuable in differentiation of small cell lymphoma from lymphoid reaction. In small cell lymphoma all cells show monotonous nuclear staining, while in lymphoid reaction it is variable Methothelioma was the last frequent cause of malignant effusions. The most discriminating feature from reactive and highly reactive effusions are morula formation, cytoplasmic vacuolation, nuclear shape [irregular and oval] chromatin pattern [irregular and hyperchromatic], and prominent nucleoli. Metholelioma cells are PAS positive and negative after diastase digestion

Fibrinolytic activity in hepatocellular carcinoma

The observed effect of hepatocellualr carcinoma on the fibrinolytic system is contradictory. This lead us to study the changes in fibrinolytic activity in 13 patients of hepatoma compared to 10 controls. Our patients especially the group with evidence of liver cirrhosis showed significant; hypofibrinogenaemia, increase in fibrinogen degradation products [FOPs], prolongation of prothrombin and thrombin time and overall reduction in prothrombin concentration. In addition there was also significant thrombocytopaenia. Such alterations favor the assumption of increased fibrinolysis and/or dissiminated intravascualr coagulation which are important factors in th pathophysiological mechanisms underlying the haemorrhagic diasthesis in patients with hepatocellular carcinoma

Conservative treatment of synaechia vulvae A clinical trial

A prospective study of 38 cases with various degrees of labial fusion in a period of 5 years was performed to study the results of local application of conjugated estrogen cream, the maximum age was 10 months. Dysuria, dribbling of urine, hematuria, itching, ambiguity of the genitalia were the main presenting symptoms. Response to that treatment was complete in a period of 2-16 weeks in all cases. Recurrence occurred in only one case and was cured by reapplication of the estrogen cream for two months

Congenital aganglionic megacolon [hirschsprung's disease] early and late results in 84 cases

Eighty-four patients with biopsy proven congenital aganglionosis were reviewed. Males predominated females, more than 50% of the patients were between one month and 2 years at the time of the diagnosis. 85.7% gave a definite history of delayed passage of meconium, 78.5% had the classical complaints, while 20% had non-specific symptoms. Barium enema alone was inconclusive in some patients and rectal biopsy is essential for the diagnosis. Five patients had a one-stage definitive operation with mortality of 40%. Preliminary colostomy was done for 79 cases; of these 15 died before definitive surgery, 21 are still awaiting the definitive operation, while 43 underwent the definitive reconstruction with a mortality of 18.6%, 23.8% following Rehbein's procedure, 14.6% following Swenson's procedure and 12.5% following Soave's operation. The results of different surgical procedures are discussed

Infantile hypertrophic pyloric stenosis: a review of 96 cases over 10 years

This study is a review of 96 cases of congenital hypertrophic pyloric stenosis admitted to the Paediatric Surgical Unit, Alexandria University in a period of 10 years [1971 to 1980 inclusive]. Of these 74 were males [77%] and 22 females [23%]. Their ages ranged from 14 days to 4 months. Thirty eight cases were first born [39.6%]. The presenting symptoms were vomiting [100%], frequent constipation [75%] and loss of weight [100%]. Pre-operative status showed varying degrees of malnutrition and dehydration in all cases. All cases were subjected to Ramstedt's operation. Post-operative mortality reached 11%

Intussusception in infancy and childhood: a review of 352 cases in ten years

An overview of the experience of the past ten years with intussusception is analysed and discussed. This entailed 352 cases admitted to the Paediatric Surgical Unit, University of Alexandria in the period from January 1971 to December 1980. The age of this series ranged between 2 months and 11 years with a peak at the age of six months. The sex incidence showed a male predominance with a ratio of 1.6:1. History of gastro-enteritis was present in 64% of cases. The leading presenting symptoms were intermittent abdominal colics [94.3%] and rectal bleeding [91.7%]. The duration of symptoms was more than two days in 184 cases. A palpable mass was present in 97.2% of the total number of cases. Barium enema was done for the rest of the cases without masses [19 cases] to clench the diagnosis. Simple reduction was successful in 278 cases and resection was needed in 74 cases. The post-operative morbidity was encountered in the form of broncho-pneumonia, adhesive obstruction, wound sepsis and dehiscence, recurrence and adhesive obstruction in 67 cases out of the whole series. The mortality rate after simple reduction was 5%, while after resection it was 38%. The total mortality rate amounted to 11.4%

Rectal prolapse in infancy and childhood

Forty patients in the paediatric age group ranging between 9 months and 12 years, presented in the out-patient clinic of the Paediatric Surgical Unit with a protruding rectal mass. Females were predominating with a ratio of 5:3. Associated symptoms and signs were: bleeding per rectum in 62.5% of patients, perianal soiling in 50%, pallor in 17.5% and pruritus in 12.5%. Conservative management was successful in 24 cases [60%]. Six cases needed injection of 70% alcohol while in 10 cases with patulous anus, an additional modified Thiersch's operation was done. Two cases recurred after injection and, re-injection was satisfactory. On the other hand, one case recurred after circulage and it required revision of the circulage. No major complications were encountered in our series

Postoperative intestinal obstruction in infancy and childhood

Study of the post-operative intestinal obstruction in the paediatric age group is followed on the results of 714 laparotomies done in 6 years. 74 cases were recorded and analysed as regards the age, sex, type of primary intervention and type of complicating intestinal obstruction. The material of this study is discussed in a trial to disclose the different aetiological factors underlying this clinical entity