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Fifty consecutive unselected patients presenting with acute haematemesis and melaena from endoscopically confirmed bleeding oesophageal varices were treated by one-stage transabdominal oesophageal transection with gastro-oesophageal devascularization and splenectomy. According to Child's classification, 15 were Grade A, 29 Grade B and six Grade C. The mortality rate was 10 per cent. Postoperative complications included gastric fundal leak (4 per cent), pleural effusion (4 per cent), subphrenic abscess (2 per cent), atelectasis (2 per cent) and pneumothorax (2 per cent). Although five patients (10 per cent) complained of transient dysphagia during follow-up, only one (2 per cent) presented evidence of stricture at the site of oesophageal transection. Clinical encephalopathy was not present in the surviving patients in the postoperative period. No recurrence of bleeding has been recorded in the surviving patients over a follow-up period of 2-3 years.

A retrospective clinical and pathological study of 15 cases associated with schistosomiasis drawn from 1920 patients undergoing appendicectomy is discussed. The average age of the patients was 31.6 years with a 12:3 male predominance. Hepatomegaly, past or present jaundice, or splenomegaly were not observed. One patient had a previous history of similar right lower quadrant pain for several days. Eighty per cent of the cases showed an inflammatory reaction on pathological examination. In the remaining 20 per cent no inflammation was seen, but there was severe congestion mainly involving the subserosal blood vessels. Schistosoma haematobium was present in 80 per cent of the cases.

This prospective study evaluates the value of Ranson's prognostic factors in predicting severity of acute pancreatitis. One hundred-fourteen patients with 124 attacks of acute pancreatitis were studied during a 4-year period at Riyadh Central Hospital. The majority of patients were Saudi males, their mean age being 46.5 years. Cholelithiasis was the leading cause of pancreatitis. Ranson's 11 prognostic factors were estimated within 48 hours of admission. Sixty-six percent of the cases were graded as mild pancreatitis with less than 3 Ranson's factors present, whereas 34% were classified as severe pancreatitis with 3 or more of Ranson's factors present. Prognostic factors correctly predicted severity in 66% of patients, but only 36% from the severe group developed severe disease (complications and/or death). Overall mortality was 5.3%. Ranson's prognostic factors help in identifying severe pancreatitis but their accuracy may be improved by the use of modern imaging techniques.

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