A randomized trial of endoscopic variceal ligation versus cyanoacrylate injection for treatment of bleeding junctional varices.

Background : There is scarcity of data concerning the management of bleeding junctional gastroesophageal varices. Aim: Our aim was to compare the efficacy and safety of endoscopic variceal ligation (EVL) with cyanoacrylate injection for the treatment of bleeding junctional varices. Methods: One hundred fifty patients with bleeding junctional varices were included in the study. Patients were subjected after randomization to either EVL of junctional varices (group l: 75 patients) or cyanoacrylate injection (group ll: 75 patients). Endoscopic sessions were continued till obliteration of the varices. Clinical as well as biochemical parameters and severity of liver disease were assessed in all patients. Results: Control of active variceal bleeding was achieved in 61 patients (81%) in group I and in 68 patients (91%) in group II with no significant difference (p =0.07). Re-bleeding was seen in 12 patients (16%) in group I and 5 patients in group II (6%). Junctional varix obliteration was achieved after one session in 33% of patients in group I and 52% of patients in group II, however after 2 sessions it was achieved in 67% in group I and 93 % in group II. After 3 sessions variceal obliteration was achieved in 99% in group l. Fever, chest pain and dysphagia were observed more frequently in group II than in group I. Long term complications including spontaneous bacterial peritonitis, hepatic encephalopathy and hepatorenal syndrome were also observed more frequently group II than in group I. Conclusion: EVL may be a good alternative to cyanoacrylate injection in treatment of bleeding junctional varices.

distal fascicle of the anterior inferior tibio-fibular ligament in correlation with talar impingement

Up till now, the anterior inferior tibiofibular ligament [AITFL] is described in the anatomic tradition as one entity. The present investigation confirmed the presence of what was recently termed [a distal fascicle] of the ligament, which appeared as a separate band found in all [thirteen] the examined cadavers. It took the shape of a parallelogram that lied below and parallel to the rest of the AITFL. A pad of fat separated this fascicle from the rest of the ligament that masked its easy differentiation for a long time. In extreme dorsiflexion of the ankle, the lower border of the fascicle became tight and touched the dome of talus. Also, the clinical study showed audible popping and friction between the thickened fascicle and the opposite hyaline cartilage on talus. This indicated a ligamentous talar impingement with chronic pain on the anterolateral aspect of the ankle in 5 out of 9 patients with soft tissue talar impingement syndrome related to the anterolateral compartment of the ankle. Arthroscopic resection of the distal fascicle gave excellent results with complete relief of pain in all 5 patients suffering of this lesion. Arthroscopic removal of this fascicle along with treatment of other offending pathological lesions gave excellent results in 8 out of 9 patients after an average follow up of 13 months. It was concluded that the anatomy of this distal fascicle has to be included in literature. Furthermore, its pathologic role in talar impingement should be appreciated, yet not overemphasized by clinicians and those dealing with sport injuries, especially when exostoses are absent in radiographs

range of morphological variation of the middle meatus of the nose in cases without clinical sinusitis

Twenty cadaveric head regions were sagitally sectioned and examined for the anatomy of the middle meatus region. Serial coronal CT section [1-3 mm] of fifty persons were done. Twenty five of tehm belong to patients suffering from chronic sinusitis, and the other twenty five of sinusitis-free persons. Selected measures were applied on both cadaveric speciments and coronal CT scans. The results of the present study showed a wide range of anatomical cariations in this region, even in the sinusitis-free. Certain anatomical structures showed marked discrepancy in frequency of variations or its dimensions in patient suffering from chronic sinusitis in relation to sinusitis-free persons. The most important variation in the middle turbinate was the concha bullosa which was present in 28% of sinusitis-free bit it was found in 52% of sinusitis patients. Also, the curvature of the middle turbinate was abnormal in 20% sinusitis patient while no cases of abnormal curvature were recorded in sinusitis-free persons. The distance between the middle turbinate and the bulla ethmoidalis was wider in sinusitis-free persons as it was of mean value 1.9 mm than in sinusitis patients which was of mean value 1.7 mm. As regards the uncinate process, it showed abnormal deflections in 28% of sinusitis-free persons and in 60% of sinusitis patients. Concerning the hiatus semilunaris and the infundibulum, it was found that in sinusitis-free persons the hiatus semilunaris was more wide as it was of mean value 2.7 mm while in sinusitis patients the mean width was 1.4 mm. The infundibulum depth was more shallow in sinusitis-free persons as its mean depth was 5.6 mm, while in sinusitis patients, the mean depth was 6.6 mm. Concerning the bulla ethmoidalis size, it was larger in sinusitis patients as it was of mean value 17 x 7 mm while in sinusitis-free persons, it was of mean value 14 x 6 mm. Haller's cells were detected in 28% of sinusitis-free persons and in 60% of sinusitis patients. As regards the maxillary sinus ostium, it was found that its transverse diameter was of mean value 6 mm in sinusitis-free persons while it was 3.5 mm in patients of sinusitis. Scanning of the anatomical variations and measures in cadavers and sinusitis-free persons could act as an accurate Egyptian guide serving surgical procedures. The higher incidence of variations in certain parts and discrepancy in dimensions of other parts between the sinusitis and non-sinusitis cases may support the theory that emphasizes the role of anatomical variations in the aetiology of chronic sinusitis and consequently may help to settle the controversy around this point

Ultrastructure of the ectopic eosinophilopoeitic foci in the liver and small intestine of schistosomiasis mansoni infected hamsters

Extramedullary Eosinophilopoiesis in murine schistosomiasis mansoni is thought to occur only in those tissues having a heamopoietic potential. So, the aim of this work is thought to be to investigate this belief in hamster model, by the histological examination of an organ that lacks this potential; as the small intestine. Ecotopic eosinophilic foci in different stages of maturation was seen in both the liver as well as the gut wall [ilium]. The ultrastructural features of cell population in these foci, were nearly identical in both organs. Three stages of cell maturation could be identified, resembling those described in the bone marrow. Several mitotic figures was seen, not only in the early stages but also of the adult eosinophils. The latter was more encountered in the intestine than in the liver. From the findings of this study it can be assumed that, ectopic eosinophil granulocytopoiesis can occur in any infected tissue under the effect of suitable stimuli; that means a haemoietic potential is not a must in having extramedullary eosinophilopoiesis

Premaxilla in man: a developmental and anthropological study

The premaxilla in man, whether exists as a separate bone or not, constitutes a "Problematic status". The incisive suture is currently described on the palate of children, while its facial representation is still unknown. Various anthropological and phylogenetic views appeared and based on the various degrees of development of both maxilla and premaxilla. The present study aims at finding a true anatomical data concerning the boundaries of premaxilla in man to compare it with its homologue in other mammals, and to correlate these fmdings with the precedent views. Serially-cut histological sections, at different planes, in human foetuses [4, 5 and 6 months] were examined. Dissection and maceration were applied on 3 other foetuses, 3 newlyborns and 8 children. Sixty macerated skulls of adult man, as well as of various mammals, were inspected for the presence of an incisive suture. The results obtained revealed a prenatal existence of premaxilla in man, on the contrary to what was claimed by Wood et aI [1967]. Also, it revealed a complete prenatal presence of an incisive suture, on palatal endonasal and facial aspects. Soon after birth, the sutural line disappeared completely on the facial aspect, and partly on endonasal one. On palatal aspect, it gradually and invariably disappeared in children and adult skulls. A nasal process of premaxilla in man was newly delineated, and constitutes the homologue of that present in mammals. In both gorilla and man, the so-called incisive process of maxilla [which overlaps premaxilla from infront] was not observed. In consequence, certain anthropological and phylogenetic views were discussed. Prognathism, duplicated narial margin etc... claimed to exist in negros and the so-called inferior human races, seemed to be in relation to the developmental and age changes The prenatal detection of the incisive suture may pave the way for a better understanding of the pathogenesis of the cleft palate