The value of combined use of N-butyl-2-cyanoacrylate and ethanolamine oleate in the management of bleeding esophagogastric varices.

BACKGROUND AND STUDY AIMS: Recently, tissue adhesive material has been used to improve the initial control of bleeding from huge esophagogastric varices, and to prevent them from rebleeding, in contrast to the conventional sclerotherapy. The present study assessed the value of the combined use of the tissue adhesive substance: N-butyl-2-cyanoacrylate and ethanolamine oleate 5% for management of bleeding esophagogastric varices. PATIENTS AND METHODS: One hundred and fourteen patients with documented active variceal bleeding at the time of endoscopy were alternatively randomized into two groups. The combined therapy group included 58 patients who underwent injection using both cyanoacrylate for large esophageal and gastric varices and a sclerosant agent for remaining varices. The sclerosis, or control, group included 56 patients, who underwent injection with ethanolamine oleate. RESULTS: This study proved the value of the combined therapy for the initial control of all bleeders (the follow-up period ranged from 12 to 32 months). In the sclerosis group, failure of the initial control of bleeding was reported in two cases (3.6%). Recurrent bleeding occurred in 8.6% in the combined therapy group compared to 25% in the sclerosis group (p < 0.01). Two months of therapy was required to achieve complete eradication of varices in 56.5% and 21.4% in the combined therapy and the sclerosis group, respectively. The mean number of sessions needed until the time of evaluation was 2.4 +/- 1.1 in the combined therapy group versus 5.1 +/- 2.3 sessions in the sclerosis group. The difference showed high statistical significance (p < 0.01). Minor complications occurred less frequently in the combined therapy group. Only one patient in the combined therapy group developed portal pyemia after extension of the tissue adhesive material from the site of injection into the portal vein. This patient died of hepatic failure. The mortality in the combined therapy group was lower than that in the sclerosis group (3.5% and 8.8% respectively, p > 0.05). CONCLUSION: The combined use of tissue adhesive and sclerosant materials seems to be the best plan for rapid eradication of esophagogastric varices within a short time, requiring the lowest number of injection sessions and involving minor complications and low mortality.

Acute variceal hemorrhage: the persistent bleeder. A plea for management.

A group of 1910 patients with acutely bleeding esophagogastric varices were managed in the Kasr El Aini sclerotherapy project; 458 of the patients (24%) were lost to follow-up. The remaining patients were studied in five groups: group I (294/401 patients), rigid versus flexible sclerotherapy; group II (254/336 patients), intravariceal versus paravariceal sclerotherapy; group III (174/227 patients), timing of initial sclerotherapy and the optimum frequency of sclerotherapy sessions; group IV (80/99 patients), splenectomy devascularization operation alone versus combined surgery with sclerotherapy; group V (650/847 patients), management of failures of and recurrences after sclerotherapy. The mean period of follow-up was 72 months. Rigid sclerotherapy was significantly superior to flexible sclerotherapy for emergency control of acute bleeding but was associated with significantly more morbidity. Paravariceal injection achieved insignificantly better initial control of bleeding and had more morbidity than intravariceal injection, which obliterated the varices in a significantly larger proportion of patients. Emergency injection of the acute bleeder should be carried out soon after admission, with sclerotherapy sessions repeated every 2 weeks. Combined sclerotherapy with splenectomy and devascularization was significantly more effective for controlling bleeding than surgery alone. Surgery should be done without delay for continued bleeding after the second attempt of sclerotherapy and in patients who rebleed after their third sclerotherapy session. Survival, however, was not significantly improved by the different modalities of sclerotherapy.

Endoscopic diagnosis of gastric varices.

In this retrospective study, the presence and appearance of gastric varices were analyzed among patients presenting at Kasr El Aini Hospital with variceal bleeding during the period from 1984 to 1989. Two groups of patients were studied. The first group included 970 patients with documented variceal bleeding with no history of sclerotherapy. Of these patients 6.7%, had concomitant gastric varices, and 27.1% had direct gastric extension of esophageal varices (mostly of grade 3). Gastric varices alone, without esophageal varices, were found in five cases (0.5%). The second group was a subgroup, and included 376 patients who underwent complete sclerotherapeutic eradication of varices restricted to the esophagus and were without gastric varices at the first presentation. Eleven of these patients (2.9%) developed secondary gastric varices. There was no correlation between the risk of bleeding from primary gastric varices (seen at the first presentation) and the grade of the esophageal varices. There were more bleeding episodes from large gastric varices (35.4% for the cauliflower and 16.9% for the cystic forms) than from the small varices, i.e. ruga-like and network-like gastric varices. The study also shows that the secondary development of gastric varices after endoscopic variceal sclerotherapy is a rare event, and that there was no risk of bleeding from the secondary gastric varices. Patients with esophageal varices with gastric extension had a small risk of bleeding from their gastric varices (5.2%).

Intestinal helminthic and protozoal infections and urinary schistosomiasis in Egyptian children.

To extend information on the current distribution and frequency of parasitic infections in Egypt, one stool and one urine specimen from 2945 children, aged 6 to 12 years old were examined. The children were from 10 schools, one in Cairo, 2 in Giza Governorate, and 7 in the Nile delata. Frequency rates for S. mansoni by school were 0.3% in Cairo, 8-15% in Giza, and 3-79% in the delta; for S. haematobium, rates were 3% in Cairo, 25-71% in Giza, and 0-33% in the delta. Rates for strongyloidiasis, trichuriasis, and trichostrongliasis were low in each location never exceeding 1%. Frequency rates for ascariasis were 3-31%, ancylostomiasis 3-8%, enterobiasis 2-22%, hymenolepiasis 4-20%, amebiasis 13-52%, and giardiasis 5-25%. F. hepatica infections (0.01%) were found in Sobtas, and an 8% H. heterophyes infection rate was found in Mataryia.

Size and composition of the Arab family: census and survey data.

PIP: Family characteristics in Kuwait, Bahrain, and Egypt are examined using census data from the period 1965 to 1975. A distinction is made between rural and urban families. The results suggest that the prevalence of the extended family has been exaggerated in previous studies and that most households are predominantly nuclear in type.^ieng