Esophageal strictures following injection sclerotherapy: risk factors and management

Injection sclerotherapy has become an effective modality for treatment of bleeding esophageal varices inspite of advancement in equipment, sclerosant solutions, and techniques. Injection sclerotherapy induced esophageal strictures remain a significant cause of patient morbidity. To evaluate the risk factors and prognosis, the records of 80 patients who underwent injection sclerotherapy over a 3 year period were reviewed. In all cases a free hand injection technique, flexible endoscopes and sodium morrhuate were used. Multiple risk factors were studied including patient age, Child's classification, previous bleeding attacks, aetiology of varices, amount of sclerosant used, and number of injection. During a mean follow up period 200 days, 25 patients [50 percent] died and 8 patients [16 percent] developed symptomatic strictures. The cumulative amount of sclerosant used [9 +/- 80m]] and the number of injection sclerotherapy [1 +/- 7] required in the stricture group was significantly greater than with the nonstricture group [2 +/- 45 and 4.0 +/- 2] respectively. The risk of stricture formation did not correlate to volume of sclerosant injected per treatment, cause of varices, number of previous bleeds or Child's class. Dilations was recurred for treatment of established stricture. Six patients [75 percent] required repeated dilations for four times or less. It is concluded that the risk of injection sclerotherapy can be predicted from the number of injection sclerotherapy and the cumulative volume of sclerosant required to obliterate the varices, management of strictures usually requires repeated dilations. The high mortality rate in these patients appears to reflect the severity of liver disease as 12/16 [75 percent] of deaths occurred in Child's C patients

Comparative study between different schedules for sclerosing oesophageal varices

There were no significant difference between the one-week and the 2-week interval groups with regard to total number of sclerotherapy sessions, total volume of the sclerosant used [5% ethanolamine oleate] or rate of complications, such as pyrexia, stricture ulcer and/or slough formation. Neither early nor recurrent bleeding occurred in any patient in the two groups. Eradication of varices in the 2-week interval group was achieved significantly earlier [P <0.05] than in the one-week interval group

Plasma fibronectin level in erysipelas

The level of plasma fibronectin was measured to 20 patients suffering from erysipelas and 10 normal controls. Significantly low levels of plasma fibronectin were detected in the group of patients [134 +/- 7.4 g/ml] in comparison to the normal control group [352.6 +/- 42.9 g/ml] p <0.001. This could be of prognostic value and also of therapeutic one. Some centres have tried fribronectin replacement therapy in the treatment of critically ill patients with severe bacterial sepsis

Study of cell mediated and humoral immunity in acute bacterial meningitis

Twenty [20] patients suffering from acute bacterial meningitis and ten [10] normal individuals were included in this study. Patient's age ranged from 3-50 years; they were chosen from Abassia Fever Hospital.Serum as well as CSF immunoglobulin G and M were measured at admittance and 2 days later. E rosette test was done and compared with the control group. Significant increase in IgM in CSF was recorded in early acute cases. IgG was significantly increased in CSF in both early and late cases. The increase in serum immunoglobulins was insignificant in all cases. Using E rosette test no significant difference was detected in T-lymphocytes in patient groups as compared with normal controls. From this work we can conclude that the increase in the type of CSF immunoglobulin could differentiate acute [increase in IgM] from late cases [increase in IgG]. Also we can conclude that cell mediated immunity has no role in bacterial meningitis as the increase in T lymphocytes was insignificant