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Prophylactic endoscopic sclerotherapy of oesophageal varices
Abstracts
sociated with pulmonary embolism. In no case was the patient referred for pulmonary angiography. Venography was performed in four patients, and found to be positive in three. No patient was treated for pulmonary embolism, but five received full anticoagulation (four for venous thrombophlebitis and one for a ventricular aneurysm). There were seven deaths during the index hospitalization, and seven deaths, one to five months post discharge. In no case was pulmonary embolism clinically suspected to be the cause of death, and autopsies performed on two patients revealed no evidence of pulmonary embolism. Of the 69 surviving patients not placed on anticoagulants, none were subsequently thought to have had a pulmonary embolism. The authors conclude that the short term morbidity and mortality associated with pulmonary embolism are low in patients with low probability ventilationperfusion scintigrams. [Mark Schmiedl, MD]
0 SYNGAMOSIS, AN UNUSUAL CAUSE OF ASTHMA: THE FIRST REPORTED CASE IN CANADA. Leers WD, Sarin MK, Artgyrs K. Can Med Assoc J 1985; 132:269-270. The authors report the first known case of syngamosis in a patient in Canada. The patient had traveled to the Caribbean and developed a chronic cough, which was felt to be asthma. Symptoms persisted despite an initially negative workup and standard therapy. Only after bronchoscopic examination was the diagnosis of Syngamus laryngeus made when the worms were noted in the trachea and seen in bronchial washings. S laryngeus is found in bird and mammals in the tropics and only rarely infects humans as an accidental host. The authors suggest that this diagnosis along with other conditions that can simulate asthma, such as hookworm, Filaria, Schistosoma and Ascaris, be kept in mind in light of the increasing number of travelers to the [Eric Simrod, MD] Caribbean.
? ?PROPHYLACTIC ENDOSCOPIC SCLEROTHERAPY OF OESOPHAGEAL VARICES. Witzel L, Wolbergs E, Merki H. The Lancet Apr 6, 19851773-775. The authors prospectively studied 109 patients with cirrhosis and endoscopically demonstrated esophageal varices. These patients had not previously bled from their varices. Fifty six
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patients were treated with prophylactic sclerotherapy, and 53 were managed conservatively. Each group was divided into three groups based on varix size and Child’s classification of liver disease. It appeared that varix size was directly related to the severity of hepatic disease and that frequency of hemorrhage in the control group was directly related to varix size. Prophylactic sclerotherapy diminished the frequency of variteal bleeding and mortality. Over an approximate two-year period the frequency of bleeding was 9% in the therapy group compared with 57% in controls (PC .Ol); mortality rates were 23% and 55%, respectively (P<.O2). The authors conclude that the frequency of bleeding and mortality from esophageal varices are reduced by prophylactic endoscopic sclerotherapy. Further investigation is needed before general recommendations for preventive sclerotherapy can [Tom Drake, MD] be made. Editor’s Note: It would certainly be wonderful to find a therapy that would minimize bleeding without increasing encephalopathy. The reduction in the need for blood (a commodity always in short supply) might alter attitudes in the case of the cirrhotic patient to reduce the frustration commonly experienced in trying to care for these patients.
0 OPERATIVE INDICATIONS IN PENETRATING RENAL TRAUMA. Carroll PR, McAninch JW. J Trauma 1985; 25:587-593. In order to define precisely the indications for operative intervention in renal trauma, the authors reviewed the charts of 53 patients with a total of 56 injured kidneys from penetrating trauma. Clinical signs, degree of hematuria, wound location, and results of intravenous urography (IVU) and computed tomography (CT) were compared with the ultimate designation of major, minor, or vascular pedicle renal injury. Major injuries were defined ai deep lacerations to the corticomedullary junction involving the collecting system or major intrarenal vessels. Minor injuries included superficial lacerations, contusions, and limited retroperitoneal bleeding. IVU was performed on 39 injured kidneys, frequently yielding nonspecific findings. Six of 11 kidneys with normal urograms were subsequently shown to have suffered major injuries. Only IVU findings of nonfunction or extravasation were uniformly associated with major
sociated with pulmonary embolism. In no case was the patient referred for pulmonary angiography. Venography was performed in four patients, and found to be positive in three. No patient was treated for pulmonary embolism, but five received full anticoagulation (four for venous thrombophlebitis and one for a ventricular aneurysm). There were seven deaths during the index hospitalization, and seven deaths, one to five months post discharge. In no case was pulmonary embolism clinically suspected to be the cause of death, and autopsies performed on two patients revealed no evidence of pulmonary embolism. Of the 69 surviving patients not placed on anticoagulants, none were subsequently thought to have had a pulmonary embolism. The authors conclude that the short term morbidity and mortality associated with pulmonary embolism are low in patients with low probability ventilationperfusion scintigrams. [Mark Schmiedl, MD]
0 SYNGAMOSIS, AN UNUSUAL CAUSE OF ASTHMA: THE FIRST REPORTED CASE IN CANADA. Leers WD, Sarin MK, Artgyrs K. Can Med Assoc J 1985; 132:269-270. The authors report the first known case of syngamosis in a patient in Canada. The patient had traveled to the Caribbean and developed a chronic cough, which was felt to be asthma. Symptoms persisted despite an initially negative workup and standard therapy. Only after bronchoscopic examination was the diagnosis of Syngamus laryngeus made when the worms were noted in the trachea and seen in bronchial washings. S laryngeus is found in bird and mammals in the tropics and only rarely infects humans as an accidental host. The authors suggest that this diagnosis along with other conditions that can simulate asthma, such as hookworm, Filaria, Schistosoma and Ascaris, be kept in mind in light of the increasing number of travelers to the [Eric Simrod, MD] Caribbean.
? ?PROPHYLACTIC ENDOSCOPIC SCLEROTHERAPY OF OESOPHAGEAL VARICES. Witzel L, Wolbergs E, Merki H. The Lancet Apr 6, 19851773-775. The authors prospectively studied 109 patients with cirrhosis and endoscopically demonstrated esophageal varices. These patients had not previously bled from their varices. Fifty six
423
patients were treated with prophylactic sclerotherapy, and 53 were managed conservatively. Each group was divided into three groups based on varix size and Child’s classification of liver disease. It appeared that varix size was directly related to the severity of hepatic disease and that frequency of hemorrhage in the control group was directly related to varix size. Prophylactic sclerotherapy diminished the frequency of variteal bleeding and mortality. Over an approximate two-year period the frequency of bleeding was 9% in the therapy group compared with 57% in controls (PC .Ol); mortality rates were 23% and 55%, respectively (P<.O2). The authors conclude that the frequency of bleeding and mortality from esophageal varices are reduced by prophylactic endoscopic sclerotherapy. Further investigation is needed before general recommendations for preventive sclerotherapy can [Tom Drake, MD] be made. Editor’s Note: It would certainly be wonderful to find a therapy that would minimize bleeding without increasing encephalopathy. The reduction in the need for blood (a commodity always in short supply) might alter attitudes in the case of the cirrhotic patient to reduce the frustration commonly experienced in trying to care for these patients.
0 OPERATIVE INDICATIONS IN PENETRATING RENAL TRAUMA. Carroll PR, McAninch JW. J Trauma 1985; 25:587-593. In order to define precisely the indications for operative intervention in renal trauma, the authors reviewed the charts of 53 patients with a total of 56 injured kidneys from penetrating trauma. Clinical signs, degree of hematuria, wound location, and results of intravenous urography (IVU) and computed tomography (CT) were compared with the ultimate designation of major, minor, or vascular pedicle renal injury. Major injuries were defined ai deep lacerations to the corticomedullary junction involving the collecting system or major intrarenal vessels. Minor injuries included superficial lacerations, contusions, and limited retroperitoneal bleeding. IVU was performed on 39 injured kidneys, frequently yielding nonspecific findings. Six of 11 kidneys with normal urograms were subsequently shown to have suffered major injuries. Only IVU findings of nonfunction or extravasation were uniformly associated with major