We report on a 22-year-old patient with extensive urethral hemangiomas that were managed successfully by staged endoscopic sclerotherapy. To our knowledge this is the first documented use of sclerotherapy in the management of urethral hemangiomas. The rationale for using sclerotherapy in this case is discussed.

Four children, whose ages ranged from 1 to 13 years, with malacoplakia of the gastrointestinal tract were treated at King Faisal Specialist Hospital between 1979 and 1983. All patients had either a preceding or a coexisting chronic illness. In one patient, malacoplakia was an incidental finding, while the remaining three patients presented with bloody diarrhea, abdominal pain, recurrent fever, and severe malnutrition. Colonoscopy in two patients revealed markedly inflamed and friable mucosa with focal ulceration alternating with patches of normal mucosa and pseudopolyposis. They were treated with antibiotics and cholinergic agonists. Three patients responded favorably, while one patient continued to have extensive active disease. Although the response to therapy is unpredictable, patients may respond if the treatment is continued on a long-term basis.

We report a 6-month-old infant with a fibroblastic ring obstructing her hypopharynx. Surgical myotomy gave relief of symptoms.

Over a period of 36 months, 61 patients underwent sclerotherapy for esophageal varices, 49 after a variceal bleeding episode (Group I) and 12 selected patients prophylactically (Group II). Mean follow-up was 12.6 months in Group I and 15.5 months in Group II. In Group I 27% died; only 10% of those patients presenting with mild liver disease (Child's Group A) who were followed died of gastrointestinal hemorrhage; but all presenting with severe liver disease (Child's Group C) died after a mean of 6.3 months, 57% following rebleeding. No patients in Group II died from esophageal hemorrhage. The rebleeding risk per patient-month of follow-up was 0.04 in Group I, 0.005 in Group II and 0.01 in the 22% of patients in Group I who achieved complete ablation of their varices. There was no mortality attributable to the procedure, and complications occurred after only 4.5% of the procedures; all were reversible. Sclerotherapy seems at present the treatment of choice for bleeding esophageal varices, considering its efficacy, safety and simplicity. It is probably also of value prophylactically in selected patients.

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