Predictors of esophageal varices in patients of liver cirrhosis

To identify non-endoscopic predictors of esophageal varices in patients with liver cirrhosis. This observational and analytical study was carried at GI and Liver Clinic, Saeed Anwar Medical Center, Dabgari Gardens, Peshawar from January 2006 to August 2006. Seventy-three patients with established cirrhosis and no history of variceal bleeding were evaluated for predetermined variables and underwent endoscopy to look for esophageal varices. Out of 73 patients, 51 [69.9%] were males and 22 [30.1%] were females. Forty-four [60.3%] patients were having esophageal varices on endoscopy and 29 [39.7%] patients were having no varices. Out of 44 patients, small varices were found in 28 [63.6%] patients while large varices were found in 16 [36.4%] patients. Platelet count <65 x 103/ mico L. serum albumin <2.2 g/dl and portal vein diameter> 13mm on ultrasound were found to have significant predictive value for large varices. Platelet count less than 65 chi 103/ micro L, serum albumin less than 2.2 g/dl and portal vein diameter more than 13 mm on ultrasound are independent and significant predictors of esophageal varices on endoscopy. Therefore screening endoscopy must be done in all patients with liver cirrhosis who have no history of GI bleeding but any of these predictors

High peri-anal fistula, is there a place for seton in their management?

Thirty patients with high perianal fistulae were selected [22 males and 8 females with an average age ranging from 13 to 65 years] for this study. The main presenting symptoms were discharge [100%], pruritis ani [60%], pain [23.3%], swelling [16.6%], diarrhea [6.6%], constipation [6.6%] and fever [3.3%]. Fistulogram was accurate to demarcate the fistulous tract in 23 patients [76.6%] and most of the patients were managed under spinal or caudal block anesthesia. Fifteen patients were treated by fistulectomy operation [group I] and the other 15 patients were treated by cutting seton [group II]. In spite of the slight increase in pain amplitude and the increased discharge in seton group, the period of hospital stay was less [three days with seton versus seven days for fistulectomy] and the mean time needed for healing was also reduced [1.5 months for seton versus 3 months for fistulectomy]. Moreover, recurrence was encountered in only two cases after seton versus three cases after fistulectomy. However, the incidence of mild loss of sphincteric control was more after seton group [eight cases versus six cases after fistulectomy]. Most of them were slightly incontinence to flatus