message from the past: splenectomy and devascularisation with salvage sclerotherapy in the treatment of bleeding schistosomal oesophageal varices

To study the short and long term results of splenectomy and esophagogastric devascularisation in the prevention of bleeding from esophageal varices secondary to schistosomal portal hypertension. This is a retrospective prospective study of patients, who underwent splenectomy and devascularisation for schistosomal bleeding varices during the period 1980 to 1990 at Soba university hospital. They had clinical, laboratory, and endoscopic evaluation. They were followed up for a period of 10 years [mean 4.5 years]. At follow up special emphasis was laid on recurrence of variceal hemorrhage and, or mortality. Patients with recurrent variceal bleeding received emergency treatment in the form of resuscitation, balloon tamponade when necessary, and flexible endoscopic sclerotherapy. Splenectomy and oesophagogastric devascularisation was performed in 185 patients, and devascularisation only in 5 patients. Early postoperative mortality occurred in 8 patients [4.2%]. Early recurrence of variceal bleeding occurred in 4 patients who responded to emergency treatment. Transient of treatable ascitis developed in 21% of patients, transient jaundice in 12.6%, and liver failure in 1.6%. Major postoperative septic complications occurred in 6.4%. The rate of recurrence of variceal bleeding was 18.1% within the first 5 years, and 23.6% by 10 years follow-up. Late mortality occurred in 8 patients [4.4%]. The overall mortality of the procedure was 8.4%. Splenectomy and oesophagogastric devascularisation for the treatment of schistosomal portal hypertension can be associated with a high rate of variceal rebleeding. However, when coupled with sclerotherapy for recurrence, it carries an acceptable mortality rate

comparative study of laparoscopic salpingectomy versus saplingostomy in tubal pregancy

This study was performed to determine whether Laparoscopic Salpingostomy [L.os.] is preferable to Laparoscopic Salpingectomy [L.ec.] in the management of un-ruptured tubal pregnancy. Fifty patients diagnosed as un-ruptured tubal pregnancy were prospectively randomized to either [L.os.] or [L.ec.] from the emergency department of Obstet. Gynec, Zagazig University Hospital in the period between 1996 and 1998, each group included 25 patients. The two groups were compared for operation time, amount of blood loss, duration of hospital stay, persistence of ectopic pregnancy, decrease in level of beta-HCG and fertility outcome. The [L.ec.] group had a longer operative time, shorter hospital stay, lower incidence of persistent trophoblastic activity than the L.os. group [p<0.01]. Time interval until beta-HCG < 10 mU /ml and subsequent normal pregnancy rates were similar. Two repeat tubal pregnancies occurred in the [L.os.] group while non-noted in the [L.ec.] group in the follow up period of two years