Endoscopic band ligation of internal haemorrhoids versus stapled haemorrhoidopexy in patients with portal hypertension

Portal hypertension is common in Egypt as a sequela to the high prevalence of hepatitis C virus and bilharziasis. In portal hypertension internal haemorrhoids are frequently found. The aim of this work was to compare the outcome of endoscopic band ligation [EBL] of symptomatic internal haemorrhoids with that of stapled haemorrhoidopexy [SH] in Egyptian patients with portal hypertension. In this study, 26 portal hypertensive patients [with oesophageal and/or fundal varices] with a grade 2-4 internal haemorrhoids who had no coagulation disorders were randomised to treatment by EBL [13 patients] or SH [13 patients] after doing colonoscopy. Symptom scores of bleeding and prolapse were assessed before and after the intervention. Complications were recorded. Patients were followed up for 12 months. Goligher's grades of internal haemorrhoids improved significantly [p=0.018] 12 weeks after SH [from 2.9 +/- 0.8 to 0.4 +/- 0.5; p=0.001] and after EBL [from 2.8 +/- 0.8 to 1.1 +/- 0.8; p=0.001]. Symptom [bleeding and prolapse] scores significantly improved 4 weeks after both EBL [from 1.6 +/- 0.8 to 0.6 +/- 0.8; p<0.001 and from 1.6 +/- 0.9 to 0.5 +/- 0.5; p=0.002, respectively] and SH [from 1.8 +/- 0.8 to 0.2 +/- 0.4; p=0.002 and from 1.5 +/- 0.9 to 0.2 +/- 0.4; p=0.001, respectively]. The differences after 4 weeks between EBL and SH were not significant [p=0.168 and p=0.225]. Pain requiring analgesics occurred in five patients [38.5%] after EBL, compared with six [46.2%] after SH [p=0.691]. Minimal bleeding occurred in two patients [15.4%] after EBL but not with SH; urinary retention was observed in one patient after EBL compared with two after SH; and anal fissures were observed in one patient after EBL. During 1-year follow-up, increased frequency of stool occurred in one patient after EBL. Recurrence of symptoms was observed in three patients after EBL and in one after SH. For portal hypertensive patients with internal haemorrhoids and without coagulation disorders SH seems to be superior to EBL. However further studies are needed to evaluate EBL in different grades of cirrhosis

Malaria in Egypt, Saudi Arabia and Yemen: a clinical pilot study

Imported malaria is a health problem and needs continuous monitoring as many clinicians are not aware of it. In Yemen malaria is the main public health problem. Malaria cases were 16 in Almaza Military Fever Hospital, Cairo, 53 in Saudi Hospital at Pilgrimage, Yemen and in Saber Hospital at Aden, Yemen were studied. 9 cases [56.2%] of P. falciparum in Cairo were imported and 7 cases [43.8%] acquired P. vivax locally [October 2003 to July 2004]. They were all treated successfully by chloroquine. An imported case [6.3%] died by cerebral malaria due to delayed diagnosis. Five imported cases [31.3%] had severe malaria. In Pilgrimage, an infant [1.9%] had congenital malaria, 17 cases [32.1%] had severe malaria and 2 [3.8%] died by cerebral malaria. 43 patients [81.1%] had P. falciparum and 10 patients [18.9%] had P. vivax. All patients were treated by parenteral or oral quinine. In Aden, one patient [5%] suffered diarrhea without fever, early blood film was negative, and was positive later on. 18 cases [90%] had P. falciparum, 2 [10%] had P. vivax. 4 cases [20%] had severe malaria and a patient [5%] died by cerebral malaria. Patients in Aden severe cases were successfully treated by intramuscular artemether followed by oral Fansidar, and mild ones were treated by oral Quartem

Upper esophageal sphincter pressure in patients with gastro-esophageal reflux disease

The upper esophageal sphincter is a major component of airway protective mechanism against entry of gastro-esophageal refluxate into the aero-digestive tract. Upper esophageal sphincter function in patients with GERD is not completely elucidated. To study resting upper esophageal sphincter [UES] pressure in patients with gastro-esophageal reflux disease [GERD]. 24 patients with GERD were included in the study. 16 of them were males and 8 were females. Their ages ranged from 7 years to 35 years. Also, 10 healthy control subjects were included in the study. Upper endoscopy and/or 24 pH monitoring were performed to patients. Esophageal motility study was performed to all subjects. 24 patients had heartburn, 6 had regurgitation and 6 had epigastric pain. By endoscopy, 10 patients had linear erosions, 2 had confluent erosions and 12 had non-erosive reflux disease. The lower esophageal sphincter [LES] pressure was significantly lower in patients [11.95 +/- 5.28 mmHg] compared to control subjects [27.05 +/- 4.69 mm Hg]. The upper esophageal sphincter [UES] pressure was also significantly lower in patients [54 +/- 32.23 mm Hg] compared to control subjects [89.9 +/- 12.7 mm Hg]. UES motility disorder is found in patients with GERD

Study of colorectal polyps in Sharkyia, Egypt

In present work, location, histopathological features and complications of endoscopic excision of different colorectal polyps were studied. Data were collected prospectively during colonoscopic examination performed to 592 subjects at Endoscopy Units, Zagazig University Hospitals, Sharkyia, Egypt. The study was performed from April 2003 till July 2007. Colorectal polyps were found in 112 patients [18.9%]. 60 patients [53.6%] were males, and 52 patients [46.4%] were females. The age of the patients ranged from 3.5 to 68 years. 71 patients [63.4%] were children and adolescents. Bleeding per rectum presented in 84 patients [75%], hypochromic microcytic anaemia in 5 patients [4.5%] and bowel disturbances in 20 patients [17.8%]. Screening colonoscopy was performed in 3 patients [2.7%]. Polyps were located in the proximal colon in 23 patients [20.5%], distal colon in 83 patients [74.1%] and diffuse involvement in 6 patients [5.35%]. One patient [0.89%] had bleeding after polypectomy necessitating admission and blood transfusion. 53 patients [48.2%] had juvenile polyps, 22 [20%] had adenomatous polyps, 20 [18.2%] had inflammatory polyps, 5 [4.5%] had bilharzial polyps, 4 [3.6%] had pseudopolyps of ulcerative colitis, 3 [2.7%] had familial polyposis coli, one [0.9%] had malignancy inside adenomatous polyp, one [0.9%] was associated with rectal prolapse and one [0.9%] was associated with sutures of previous operation of rectal prolapse. Histopathological specimens were not available in 2 patients. Juvenile polyps were the most frequent polyps in our study. The low number of bilharzial polyps points to the decreasing prevalence of bilharziasis in Egypt nowadays. Polyps are located mainly in the distal colon. Endoscopic polypectomy had few complications