Biliary-enteric by pass versus percutaneous transhepatic biliary drainage [PTDD] in the management of biliary obstruction in patients with unresectable carcinoma of the pancreas

50 patients, 42 males and 8 females with an average age of 67 years. All were admitted to the hospital with an advanced carcinoma of the head of pancreas. Palliation was done to relieve the jaundice and improve the general condition of patients. 36 patients had biliary enteric by pass and 14 patients had PTBD. The results showed that those patients with biliary enteric by pass stayed less in the hospital and lived longer than those with PTBD

Highly selective vagotomy and duodenal ulcer that fail to respond to H2 receptor antagonists

100 patients [80 males and 20 females] during a 4 year study period underwent hihgly selective vagotomy for uncomplicated duodenal ulcer. The study included 33 patients whose ulcers had not responded to the receptor blockers, 12 patients suffered recurrent ulceration while receiving H2 receptor antagonist maintenance therapy. 42 patients whose ulcers had healed with H2 blockers but who had relapses after cessation of the therapy, and 13 patients who had never been treated with H2 receptor antagonist therapy Our results showed that the highest rate of recurrence was seen in the group whose ulcers were refractory to H2 receptor antagonists. This may indicate that duodenal ulcer failing to respond to H2 receptor antagonists represent a more severe ulcer diathesis for which highly selective vagotomy is less effective

Changes in the fibrinolytic activity of blood after surgical treatment of malignant diseases

In this study we examined one hundred patients for the effect of malignant disease on the blood fibrinolytic activity [FA]. We also looked for differences in fibrionlytic and coagulation parameters before and after surgical removal of the malignant tumors. Fifty eight males and forty two females were divided into two groups; malignant and control groups. The patients were examined clinically and laboratory before and after surgery and we excluded those with any physiological condition that may directly alter our parameters. The FA was examined by the fibrin plate method. We have found a highly significant lowering of FA in the malignant group in comparison with the control group. The most striking result of this study was the increase in FA in malignant patients after surgical removal of their tumors. A highly significant difference has been detected. The control group of patients who underwent a variety of operations for benign lesions did not show significant changes in FA after surgery. We suggest that the lowered FA in the course of malignant disease is due to increased levels of circulating specific fast-acting plasminogen activator-inhibitor [PAI] and that this PAI is produced not only within the tumor mass but also systemically from the liver, vascular endothelium and platelets. *FDP assay showed also important results. Most of cancer patients have abnormally high FDP levels in their serum. The concomitant lowered FA in cancer patients raises the possibility that the high FDP levels in cancer patients results from extra vascular breakdown of fibrin by malignant cells and/or from a subclinical process of intravascular coagulation and fibrinolysis. After surgical removal of malignant- tumors, the FDP levels increased and we ascribe this is to the improved FA after surgery in those patients. *PT, *TT and *PTT did not show a significant change after surgery