role of histamine receptors antagonist [dimetindenum maleic] in schistosomal portal hypertension

Hyperhistominemia has been reported to exist in the various stages of schistosomal infection. This study was undertaken to determine the effect of dimetindenum maleic [H1 receptor blocker] on the portal pressure in schistosomal portal hypertension. Forty patients with schistosomal hepatic fibrosis were divided into 2 equal groups. Group I patients received the drug systemically by intravenous route, while patients of group II received the same dose intra-arterially into the coeliac axis trunk during splenectomy. Systemic arterial blood pressure and portal pressure were measured immediately following laparotomy, then 5, 10, 15, 20 and 30 minutes after drug injection. Both groups demonstrated significant portal pressure drop, especially, group II patients, with no significant change in systemic blood pressure. In view of this study, H1-blockers may play a role in abolishing the histamine effect in schistosomal portal hypertension

Common bile duct dynamics calculous and acalculous gallbladder disease before and after cholecystectomy

This work was carried out on 33 patients with chronic cholecystitis divided into two groups: Group 1 included 20 patients with calculus cholecystitis and group 2 included 13 patients with acalculus cholecystitis. The diagnosis was established by oral cholecystography and ultrasonography. The common bile duct [CBD] diameter was measured preoperatively. All patients of group 1 and group 2 were submitted to cholecystectomy. Preoperative measurements of CBD pressure and flow before and after removal of the gall bladder were done. Measurements of CBD diameter, pressure and flow were repeated on the 4th and 10th days postoperatively. The results showed no significant difference in the CBD diameter, pressure and flow between the two groups. Following removal of the gall bladder, there was an immediate drop of both pressure and flow in both groups. Postoperative studies showed nonsignificant change in the CBD diameter in both groups. CBD pressure and flow readings returned to their preoperative values by the 10th postoperative day

Pharmacological manipulation of the lower esophageal sphincter and its impact on the variceal pressure in patients with schistosomal portal hypertension

Eighty patients and 20 volunteers included in the present study. They were divided into three groups: Group A [60 patients with schistosomal portal hypertension and esophageal varices, i.e. the study group], group B [20 patients with schistosomal portal hypertension without esophageal varices], and group C [20 normal volunteers] comprised the control group. In all subjects, the lower esophageal sphincter pressure [LOSP] was measured. Variceal pressure [VP] was measured in patients of group A using the Mossiman's pneumatic pressure gauge. Pressure measurements were repeated after administration of metoclopramide, hyoscine butyl bromide, pentagastrin and vasopressin. The results of the study showed that the mean LOSP in normal controls was 21.22 +/- 6.3 cm H2O which was significantly higher than that in group B [14 +/- 7.73 cm H2O] and group A [11.68 +/- 5.37 cm H2O]. However, there was no statistical correlation between LOSP and VP. The response of VP to the administered drugs was minimal and insignificant. Moreover, LOSP changes in groups A and B in response to these drugs were negligible compared with that in group C

study on the cyst fluid in fibrocystic disease of the breast

In the present study, the analysis of the cyst fluid of 20 patients with fibrocystic disease of the breast showed that they can be classified according to their ionic composition, in particular the level of K+, Na+ and Cl-, into two major types [I and II] and one minor less important type. Type I cyst fluid had higher levels of K+ and insignificant high levels of CEA [carcinoembryonic antigen] and alpha-fetoprotein, while type 2 contained higher levels of Na+, C1-, pH and protein. CEA and alpha-fetoprotein showed insignificant low levels in this type. When comparing the histologic findings with the biochemical composition of the cyst fluid, it can be suggested that there may be increased risk for breast cancer in women who had type I cysts. Therefore, patients with this type of fibrocystic disease of the breast should be followed up and checked periodically to detect any signs of malignancy

Does the increasing degree of ascites affect the lower oesophageal sphincter tone in schistosomal patients?

The lower esophageal sphincter [LES] pressure was measured in 20 patients with schistosomal hepatic fibrosis and different degrees of ascites and 22 patients with no ascites. No statistically significant difference in LES pressure was detected between the two groups. However, intragastric pressure was significantly higher in the ascitic group [14.3 +/- 3.5 mmHg] than those with no ascites [6.68 +/- 2.3 mmHg] and tends to increase with increasing degree of ascites. In the ascitic group, no statistically significant differences in the LES pressure could be detected between patients having mild, moderate or tense ascites. There was no reflex increase in LES pressure with the presence of ascites or its increasing degree. The prevention of gastro-esophageal reflux in these patients was probably due to the mechanical effect of increased intraabdominal pressure on the abdominal esophagus

Evaluation of drainage of the gall bladder bed after cholecystectomy

This study evaluates and presents the analysis of the result obtained from two groups of patients subjected to elective cholecystectomy; in the first group a trial was made to compare to drainage versus non drainage and in the second group comparison between two different types drains was done

Selective surgery for bleeding oesophageal varices

Two groups of schistosomal patients with history of bleeding esophageal varices were studied. Esophagoscopy, splenoportography and intra-operative portal pressure measurements from splenic, superior mesenteric, left gastric and umbilical veins were done, and according to the hemodynamic pattern, group A were submitted to selective policy, while group B were taken as controls. All group A patients had esophageal varices mostly of the moderate and severe types. Portal pressure measurements showed either positive or negative gradients with different patterns. Splenectomy and gastro- esophageal decongestion or lienorenal shunt were selected for 17 patients with positive gradient, and splenectomy alone or splenectomy plus decongestion or lienorenal shunt for 33 patients with negative gradient. Group B patients were submitted to splenectomy plus left gastric vessels legation and were taken as controls. In group A the esophageal varices disappeared or markedly regressed in 93.75%, compared to 77.78% in group B. The follow up results showed that selective policy was better in medium term follow up [7 years]

Hydatid cyst of breast

Hydatid disease of the breast is very uncommon. This study described the plain film, mammographic and ultra-sonographic pattern in two proved cases of hydatid cyst of breast, with review of literature

Evaluation of the role of plain x-ray in the diagnosis of acute abdomen

Acute abdomen in still one of the difficult problems that face the surgeons either in the diagnosis or management. In this study plain abdominal radiographs were carried out on 50 patients, excluding pregnant women, suffering from acute abdominal conditions, both traumatic and non-traumatic. The radiologist's report was assessed with the final diagnosis proved by follow up of the patient during his admission. The plain abdominal radiographs were helpful in 46% of cases. It was confirmatory to provisional diagnosis in 34% and diagnostic in 12% where provisional diagnosis was changed. The yield rate of 46% from a single investigation is considered very high if compared to the positive yield of routine biochemical investigation, which is only 18%. The stated management was changed after X-rays in 10% of cases, 4% from surgical to conservative and 6% from conservative to surgical management. It was concluded that, plain X-ray of the abdomen should become a routing investigation in the acute abdominal conditions. Erect film is more useful, but supine one is more comfortable and easier. Plain X-ray is more helpful in acute abdomen due to pathological conditions other than trauma

Evaluation of some emergency procedures in the management of acute bleeding oesophageal varices of Schistosomal origin

This study comprised 200 schistosomal patients presenting with acute variceal hemorrhage treated by four modalities. The conservative medical modality gave the least initial control rate with a 100% mortality when it was used alone in patients above 60 years, in patients with severe and/or recurrent hematemesis. The systemic intravenous vasopressin was very effective in mild and moderate cases and less effective in hematemesis of severe grade. It has the lowest mortality rate [19.1%]. Thus, it can be used as routine in the emergency treatment of variceal hemorrhage of schistosomal origin. The esophageal balloon tamponade was the most effective emergency modality in the initial control of variceal bleeding, but it had the highest recurrent rate besides it had many hazards. The emergency decongestion operation had the highest mortality rate [43.8%], this indicated that the role and the position of this operation has to be re-evaluated. Hematemesis of mild or moderate grades especially in patients presenting with their first episode did not require the use of the emergency decongestion operation. Simple measures were superior and sufficient to arrest bleeding; while, in those presenting with their second, or more bleeding episode especially when bleeding is severe it is advisable to use the esophageal tamponade as the first line of treatment followed by surgery

Effect of calcium channel blocker verapamil on gastric motility in normal individuals

This study was carried out on selected 20 subjects free from any dyspeptic troubles, 14 males and 6 females. All were subjected to routine clinical examination and laboratory investigations in addition to fluroscopic and roentgraphic study. Several factors can affect the rate of gastric emptying, e.g. myogenic, neurogenic, and hormonal. Verapamil effects on gastric motility in normal individuals were investigated in this study. It was found that IGET was not significantly changed after verapamil administration, while TGET was significantly diminished

Effect of PGE, on the composition of secretin and pancreozymin-stimulated bile in cholecystectomised patients

This study was done on 10 patients [one male and nine females] complaining of chronic non-calcular cholecystitis. Cholecystectomy and canulation of the common bile duct were performed. On the 4th postoperative day a bile sample was collected under basal condition. Then pancreozymin was infused [1 ug/kg body weight] diluted in 250 ml saline where the 2nd sample was collected. The 3rd bile sample was taken after infusion of PGFE2. For all samples, cholesterol level, phospholipids, bilirubin, sodium, potassium, calcium, and magnesium were estimated. The results were analyzed

Gall bladder motility in patients with schistosomal hepatosplenomegaly and portal hypertension

Gallbladder emptying in response to a fatty meal was studied by oral cholecystography in 60 patients with schistosomal hepatic fibrosis and 50 healthy normal volunteers. In schistosomal cases the incidence of non-visualized gallbladder was significantly higher than that of the control cases. The overall gallbladder evacuation time and the rate of gallbladder emptying were significantly delayed in the schistosomal patients. The maximum gallbladder contraction was reached after 120 minutes in the schistosomal patients and 60 minutes in the control cases. These findings should be considered when investigating patient with flatulent dyspepsia particularly or biliary origin

Gastric motility in patients with schistosomal hepatosplenomegaly and portal hypertension

Gastric emptying time was studied radiologically in 40 patients with schistosomal hepatic fibrosis and 20 normal volunteers. Schistosomal patients with dyspeptic symptoms had a significantly decreased initial gastric emptying time and a prolonged total gastric emptying time compared with that of normal controls. Patients with no dyspeptic symptoms had, however, gastric emptying times not significantly different from that of the control subjects. There was a positive relation between the total gastric emptying time and the duration of dyspeptic symptoms, but not with the degree of splenic enlargement. Schistosomal patients have, thus, an altered gastric motility which is closely related to the presence and the duration of dyspeptic symptoms

Effect of verapamil [a calcium antagonist] on the portal blood pressure in schistosomal hepatic fibrosis

The effect of intra-portal injection of verapamil on the portal venous pressure, arterial blood pressure and heart rate was studied in normal volunteers as well as in patients with schistosomal hepatic fibrosis. Portal pressure recordings were not altered by verapamil in healthy subjects, but was significantly reduced in schistosomal patients. This work showed that verapamil may have a beneficial role in the management of bleeding esophageal varices of schistosomal origin by lowering the portal venous pressure

Effect of the calcium antagonist verapamil on gastric secretion and mucosal histamine in man

The effect of i.v. injection of verapamil [5 mg] on the gastric secretion as well as mucosal histamine content was investigated in 10 healthy volunteer subjects. Gastric secretion and mucosal biopsies [from body and pylorus] were collected before and after verapamil administration. Verapamil significantly increased the volume of gastric juice, acid output and pepsin activity; however, the mucin content was not altered. During gastroduodenoscopy, after verapamil injection excess gastric juice and redness of the gastric mucosa were a consistent finding in all cases. The drug caused nonsignificant changes in the gastric mucosal histamine content whether in the body or the pylorus regions. The study suggested that gastric secretory stimulation of verapamil might not be mediated by mucosal histamine, but it could be attributed to the vasodilator effect of the drug

Effect of verapamil on histamine and pentagastrin-stimulated gastric acid secretion in man

The effect of verapamil on the histamine and the pentagastrin-stimulated gastric acid secretion had been studied in normal volunteers. Histamine, pentagastrin, or verapamil increased the volume of gastric secretion and acidity when given separately. However, when histamine was followed by verapamil, the volume and acidity dropped, while pentagastrin followed by verapamil administration did not alter the volume nor the acidity. On the other hand, when histamine was proceeded by verapamil, a nonsignificant drop in volume and a significant drop in acidity could be traced, but pentagastrin proceeded by verapamil administration caused a nonsignificant rise in the studied parameters. The data suggested that calcium partly acts as a second messenger, together with cAMP, in the histamine-induced gastric acid secretion. While, the role of calcium in the gastrinergic pathway remains to be further elucidated

Assessment of cryohaemorrhoidectomy as an alternative method for operative haemorrhoidectomy

This study was carried out on 50 patients with second and third degree piles, 25 patients were treated with ligation-excision operation and 25 patients by cryotherapy, A follow-up period of six weeks to assess both procedures led us to conclude that: cryohaemorrhoidectomy is a painless procedure, characterised by a smoother post-operative course which allowed immediate ambulation. It is an effective alternative to ligation and excision in patients with bleeding internal haemorrhoids with no skin covered component and in those who refuse surgical excision, or are unfit for anaesthesia. Cryohaemorrhoidectomy is, however, unsuitable for patients whose main symptom is prolapse as it is followed by a higher incidence of residual piles

Assessment of some roles of the spleen in humoral immunity in patients, with Schistosomal hepatic fibrosis and splenomegaly

The study was conducted on twenty patients suffering from Schistosomal hepatic fibrosis and splenomegaly to assess the role of the spleen in humoral immunity by comparing splenic arteriovenous immunoglobulin differences in relation to systemic and splenic tissue levels and the demonstration of immune complex in the spleen. The results of this study show that the spleen is immunologically active in case of schistosomal hepatic fibrosis sharing in the synthesis of both IgG and IgM in excess amounts due to its activation by schistosomal antigen, while it has no significant effect on IgA