Relationships and boundaries: Learning needs and preferences in clerkship medical environments.

PURPOSE: Relationship boundaries recognition is an essential element of medical practice. The aim of the study was to assess final year medical students' perceived need for education regarding professional boundaries. MATERIALS AND METHODS: This was a cross-sectional study. An anonymous paper questionnaire was distributed to 128 final year medical students. Standard descriptive statistics, unpaired t-test to evaluate differences between male and female groups and Pearson correlation to determine relationships between variables were used. RESULTS: The survey was completed by 84.4% of students who identified the need for more emphasis in the curriculum for all of topics during training and practice pertaining to boundaries and relationships (mean 6.61±1.32 on a scale of 0 to 9; and 6.66±1.27 respectively). Topics with a high interest ranking requiring additional attention were mistreatment of medical students (mean 7.22±1.96), coping with mistakes in clinical care (mean 7.25±1.63), reporting of medical mistakes (mean 7.58±1.36), and gender bias in clinical care (mean 7.10±1.82). Women perceived a greater need for attention to all topics in the curriculum. Significant differences between the perceptions of female and male students were observed regarding topics such as responding to an impaired colleague (p<0.001), and a physician's social responsibilities (p = 0.001). CONCLUSION: Medical students recognized the need for more education and training in the undergraduate medical ethics curriculum regarding patient-physician relationship boundaries.

Informed consent learning: Needs and preferences in medical clerkship environments.

PURPOSE: Limited information exists regarding students' routine educational needs in support of ethics and professionalism practices faced in real clinical practice. As such the authors aimed to explore medical students learning needs and preferences for informed consent and relevant ethical issues in the clerkship environments. MATERIALS AND METHODS: A cross-sectional study using a self-administered, printed survey distributed to final year clinical clerks. RESULTS: 84% completed the survey. Students indicated the need for more attention to all topics related to informed consent (mean = 7.1 on a scale of 0 to 9; ±1.2). Most additional instructional attention was requested for topics raised in discussions with patients concerning the risks, benefits and alternatives to recommended treatments (7.3 ±1.4). The cohort expressed the need for education in the care of vulnerable patients (7.2 ±1.2) with a maximum score for the care of abused children. Women perceived greater need for education concerning informed consent than male respondents (p>0.05). There were significant differences between students who scored high or low on the item "being treated in professional manner" and "endorsement of educational needs for care of adolescents" (p = 0.05). CONCLUSION: There was heightened perception among final year medical students of the need for greater attention to be paid to informed consent education.

Ethics teaching in a medical education environment: preferences for diversity of learning and assessment methods.

BACKGROUND: Ethics and professionalism are an integral part of medical school curricula; however, medical students' views on these topics have not been assessed in many countries. OBJECTIVE:  The study aimed to examine medical students' perceptions toward ethics and professionalism teaching, and its learning and assessment methods. DESIGN: A self-administered questionnaire eliciting views on professionalism and ethics education was distributed to a total of 128 final-year medical students. RESULTS: A total of 108 students completed the survey, with an 84% response rate. Medical students reported frequently encountering ethical conflicts during training but stated only a moderate level of ethics training at medical school (mean = 5.14 ± 1.8). They noted that their education had helped somewhat to deal with ethical conflicts (mean = 5.39 ± 2.0). Students strongly affirmed the importance of ethics education (mean = 7.63 ± 1.03) and endorsed the value of positive role models (mean = 7.45 ± 1.5) as the preferred learning method. The cohort voiced interest in direct faculty supervision as an approach to assessment of knowledge and skills (mean = 7.62 ± 1.26). Female students perceived greater need for more ethics education compared to males (p = < 0.05). Students who claimed that they had experienced some unprofessional treatment had a more limited view of the importance of ethics as a subject (P = 0.001). CONCLUSION: Medical students viewed ethics education positively and preferred clinically attuned methods for learning.

An Enhancement-focused framework for developing high quality single best answer multiple choice questions.

BACKGROUND: The primary goal of any assessment of students is to provide valid and reliable evaluations of students' knowledge and skills as well as provision of accurate feedback to students about their performance. Contrary to best practice guidelines for development of multiple choice questions (MCQs), however, items used within medical schools are often flawed. This disappoints students and discourages examiners from using in-house MCQ databases. Vetting and reviewing items can improve the quality of MCQs. In this paper, we describe our approach to standardize the format used for MCQ assessment and provide recommendations for quality enhancement of high-stakes assessment. METHODS: A collaborative enhancement-focused vetting and review approach to development of high quality single best answer MCQs has been described. RESULTS: Implementation of a collaborative strategy to blueprint, vet, review and standard set MCQ items for high stakes examinations can effectively contribute to assessment quality assurance. Similarly, shared responsibility for post examination analyses of items may reveal the psychometric properties of items in need of improvement and contribute to closure of the assessment outcomes feedback loop. DISCUSSION: Devolving responsibility for implementation of assessment processes as an integral part of educational practices and values can maximize reliability and standards of assessment processes. We contend that while logistics and time constraints are of concern to busy faculty members, judicious utilization of resources to develop well-written MCQ items are well worth the effort to produce reliable and valid examinee scores. An enhancement-focused approach can be institutionally rewarding and lead to improved quality of high stakes assessments.

Factors affecting success rate of Advanced Trauma Life Support (ATLS) courses.

BACKGROUND: The aim of the present study was to define the factors that affect passing the assessments for successful completion of the Advanced Trauma Life Support (ATLS) Provider Courses in the United Arab Emirates (UAE). METHODS: The ATLS Provider Course has been taught in three medical centers in the UAE since 2004. A total of 1,041 doctors completed the course during the period 2004-2010. A special protocol was designed to enter data accrued for each course, participants' demographics, and assessments, including the final results. Direct logistic regression was performed to define factors affecting success in multiple choice questions (MCQ) and in the practical initial assessment station exam. The studied variables included the year, the course site, speciality, level of practice, and pre-test score. RESULTS: The majority of participants were surgeons (33.2 %), followed by Emergency Medicine physicians (27.3 %). The logistic regression model showed that having a low pre-test score (p < 0.0001) and being a family medicine practitioner (p < 0.0001) increased the likelihood of failing the MCQ exam. The chance of passing the end of course practical exam increased with time (p = 0.002). A low pre-test score (p < 0.0001) and being examined in site A (p = 0.04) increased the chance of failing in the initial assessment exam. The pass rate for the ATLS exam significantly increased after adoption of the interactive approach to teaching. CONCLUSIONS: Prior knowledge and preparation is essential to passing the ATLS exam. Doctors who deal clinically with all aspects of airway, breathing, and circulation of the ATLS course are more likely to pass the MCQ exam in our setting, followed by those who usually manage only the circulation or disability aspects of ATLS. It is possible that the interactive approach to teaching ATLS has improved the overall ATLS success rate.

Educational and clinical impact of Advanced Trauma Life Support (ATLS) courses: a systematic review.

BACKGROUND: We aimed to systematically review the literature on the educational impact of Advanced Trauma Life Support (ATLS) courses and their effects on death rates of multiple trauma patients. METHODS: All Medline, Pubmed, and the Cochrane Library English articles on the educational impact of ATLS courses and their effects on trauma mortality for the period 1966-2012 were studied. All original articles written in English were included. Surveys, reviews, editorials/letters, and other trauma courses or models different from the ATLS course were excluded. Articles were critically evaluated regarding study research design, statistical analysis, outcome, and quality and level of evidence. RESULTS: A total of 384 articles were found in the search. Of these, 104 relevant articles were read; 23 met the selection criteria and were critically analyzed. Ten original articles reported studies on the impact of ATLS on cognitive and clinical skills, six articles addressed the attrition of skills gained through ATLS training, and seven articles addressed the effects of ATLS on trauma mortality. There is level I evidence that ATLS significantly improves the knowledge of participants managing multiple trauma patients, their clinical skills, and their organization and priority approaches. There is level II-1 evidence that knowledge and skills gained through ATLS participation decline after 6 months, with a maximum decline after 2 years. Organization and priority skills, however, are kept for up to 8 years following ATLS. Strong evidence showing that ATLS training reduces morbidity and mortality in trauma patients is still lacking. CONCLUSIONS: It is highly recommended that ATLS courses should be taught for all doctors who are involved in the management of multiple trauma patients. Future studies are required to properly evaluate the impact of ATLS training on trauma death rates and disability.

Upregulation and inhibition of the nuclear translocation of Oct4 during multistep gastric carcinogenesis.

Gastric cancer is the fourth most commonly diagnosed malignancy and the second leading cause of cancer-related mortality worldwide. Recent research suggests that tissue stem cells and the self renewal transcription factor, octamer-binding transcription factor 4 (Oct4), could be involved in the development of certain tumors. The aim of this study was to investigate the expression pattern of Oct4 in normal human stomach and during multistep gastric carcinogenesis. Pyloric antral mucosal tissues were obtained from consenting individuals undergoing endoscopy (due to upper gastrointestinal symptoms) and gastrectomy (due to pyloric antral adenocarcinoma). Some tissue samples were processed to assemble an array of tissue sections representing multistep carcinogenesis and probed using anti-Oct4 antibodies and lectins specific for α-L-fucose or N-acetyl-D-glucosamine. Some tissue samples were processed for subcellular fractionation and western blot analysis using the same antibodies. The results revealed that Oct4-expressing cells were found in the proliferative cell compartment of the pit-gland units of microscopically normal gastric mucosal biopsies. Mucosal tissues with evidence of severe gastritis, metaplastic/dysplastic transformation and gastric cancer showed a significant increase in the expression of Oct4 (the labeled area increased from 2% in the control to 6 and 16% in the gastritis and cancerous tissues, respectively), suggesting a role for Oct4 in the early stages of cancer development. Furthermore, the data revealed an alteration in the subcellular distribution of Oct4, possibly due to the inhibition of cytoplasm-to-nucleus translocation during carcinogenesis. In conclusion, this study demonstrates an alteration in the expression pattern and nuclear translocation of Oct4 during gastric carcinogenesis and may be helpful in designing new modalities for the early detection and/or therapy of gastric cancer.

Pediatric trauma research in the Gulf Cooperation Council countries.

BACKGROUND/OBJECTIVE: To review published pediatric trauma research from the Gulf Cooperation Council (GCC) countries so as to identify research fields that need to be enhanced. METHODS: A MEDLINE search for articles on pediatric trauma from GCC countries during the period 1960 to 2010 was performed. The content of articles was analyzed, classified and summarized. RESULTS: Fifty-three articles were found and retrieved of which 18 (34%) were published in the last 5 years, 42 (79.2%) were original articles. The first author was affiliated to a university in 29 reports (54.7%), to a community hospital in 13 (24.5%) and to a military hospital in 10 (18.9%). All articles were observational studies that included 18 (34%) case-control studies, 18 (34%) case reports/case series studies, 8 (15.1%) prospective studies, and 7 (13.2%) cross sectional studies. The median (range) impact factor of the journals was 1.3 (0.5-3.72). No meta-analysis studies were found. CONCLUSION: A strategic plan is required to support pediatric trauma research in GCC countries so as to address unmet needs. Areas of deficiency include pre-hospital care, post-traumatic psychological effects and post-traumatic rehabilitation, interventional studies focused on a safe child environment and attitude changes, and the socioeconomic impact of pediatric trauma.

Camel-related injuries: prospective study of 212 patients.

BACKGROUND: Camel-related injuries have been less well studied than other animal-related injuries. We aimed to study prospectively the incidence, mechanism, distribution of injury, and outcome of patients admitted to hospital with camel-related injuries in Al-Ain, United Arab Emirates. METHODS: All patients who were admitted to Al-Ain Hospital with a camel-related injury were prospectively studied during the period of October 2001 to January 2010. Patient's demography, time of injury, mechanism of injury, and distribution and severity of injury were studied. RESULTS: A total of 212 patients, all male, with a median age of 28 years (5-89 years) were studied. The estimated incidence of hospitalized camel-related injured patients in Al-Ain City was 6.88 per 100,000 population per year. Camel kicks were most common (36.8 %) followed by a fall from a camel (26.4 %) and camel bites (25.0 %). Camel kicks and falling from a camel were more common during the hot month of August, and camel bites were more common during the rutting season (November to February). Patients with a kick-related injury had a significantly higher rate of maxillofacial fractures compared with other mechanisms. Spinal injuries occurred significantly more often in vehicle occupants who collided with camels compared with other mechanisms (3/7 compared with 7/205, p = 0.0022, Fisher's exact test). Twelve patients (5.7 %) were admitted to the intensive care unit. The mean hospital stay was 8.6 days (1-103 days). Two patients died (overall mortality 1 %). CONCLUSIONS: Understanding the biomechanisms and patterns of injury and correlating them with the behavior of the camel is important for identification and prevention of camel-related injuries.

Prevention of child camel jockey injuries: a success story from the United Arab Emirates.

OBJECTIVE: To study the effects of a law banning children from taking part in camel racing on child camel jockey injuries in Al-Ain City, United Arab Emirates. DESIGN: Prospective study. SETTING: University Teaching Hospital. PATIENTS: All patients who were admitted to Al-Ain Hospital and were injured while riding camels were prospectively studied between January 1, 2002, and December 31, 2009. ASSESSMENT OF RISK FACTORS: Two periods, before the law and after its introduction, were compared. MAIN OUTCOME MEASURES: Pediatric injuries, their anatomical distribution, and severity of injury. RESULTS: Fifty-four patients were studied, and all were males. There were 13 children and 41 adults. All children were camel jockeys except 1 child who was riding a camel for fun. None of the adult camel riders was a camel jockey. The median (range) age of patients admitted before the law was 12.5 (5-45) years, which was significantly less compared with 27.2 (20-40) years after its introduction (P = 0.001, Mann-Whitney test). All 13 children sustained their injuries before the law was implemented, whereas 12 of 41 adults sustained their injuries before the legislation was in place (P < 0.0001, Fisher exact test). The total length of hospital stay of patients was significantly reduced after the law enforcement (P < 0.01, Mann-Whitney test). CONCLUSIONS: Our findings emphasize the important role of law enforcement in injury prevention, illustrated by the replacement of children by robot substitutes. This is possibly one of the few examples where child injury has been completely prevented by legislation.

Camel bite injuries in United Arab Emirates: a 6 year prospective study.

PURPOSE: To prospectively study the incidence, mechanism, distribution of injury, and outcome of patients admitted to Al-Ain Hospital with camel bite injuries in Al-Ain, United Arab Emirates. METHODOLOGY: All patients admitted to Al-Ain Hospital with a camel bite were prospectively studied during the period of October 2001-October 2007. Patient's demography, mechanism of injury including behaviour of the camel, distribution and severity of injury, and outcome were studied. RESULTS: 33 patients were studied having a median (range) age of 27 (10-58), all were males. 97% were from the Indian subcontinent. A majority of injuries (73%) occurred during the camel rutting season (November-March). Twenty-five patients were camel caregivers whilst five were camel jockeys. All camel jockeys were children. Seven patients were raised up by the camel's mouth and thrown to the ground whilst 26 patients were only bitten. Most injuries were in the upper limb (64%) and head and face (15%). 48% of upper limb injuries had associated fractures. Two patients who were bitten at the neck were admitted to the ICU. One of these died due to massive left-brain infarction and the other had complete quadriplegia due to spinal cord injury. The median hospital stay was 6 days. There was only one death (3%). CONCLUSION: The behaviour of the camel is occasionally unpredictable, especially during the rutting season. The mechanism of camel bite injuries, which are usually severe, are complex including penetrating and crushing injuries by the camel jaw and blunt injuries when patients are picked up and thrown away. Care should be taken when handling camels, particularly in the rut.

The long term effects of early analysis of a trauma registry.

BACKGROUND: We established a trauma registry in 2003 to collect data on trauma patients, which is a major cause of death in the United Arab Emirates (UAE). The aim of this paper is to report on the long term effects of our early analysis of this registry. METHODS: Data in the early stages of this trauma registry were collected for 503 patients during a period of 6 months in 2003. Data was collected on a paper form and then entered into the trauma registry using a self-developed Access database. Descriptive analysis was performed. RESULTS: Most were males (87%), the mean age (SD) was 30.5 (14.9). UAE citizens formed 18.5%. Road traffic collisions caused an overwhelming 34.2% of injuries with 29.7% of those involving UAE citizens while work-related injuries were 26.2%. The early analysis of this registry had two major impacts. Firstly, the alarmingly high rate of UAE nationals in road traffic collisions standardized to the population led to major concerns and to the development of a specialized road traffic collision registry three years later. Second, the equally alarming high rate of work-related injuries led to collaboration with a Preventive Medicine team who helped with refining data elements of the trauma registry to include data important for research in trauma prevention. CONCLUSION: Analysis of a trauma registry as early as six months can lead to useful information which has long term effects on the progress of trauma research and prevention.

Peritoneal resorption capacity for the inflammatory mediators in acute experimental Staphylococcus aureus peritonitis.

BACKGROUND: Elevations in both endotoxin and interleukin-6 (IL-6) concentrations in peritoneal exudates are a thousand times higher than their respective concentrations in the peripheral blood in patients with gram-positive or gram-negative peritonitis. We aimed in this study to evaluate the resorption capacity of the peritoneum for endotoxin and IL-6 in a model of bacterial (gram-positive) peritonitis. METHODS: Intraperitoneal (i.p.) injection of mucin-pretreated staphylococci in phosphate buffered saline (PBS) or of PBS alone was performed in 93 male Wistar rats. Studies of resorption were undertaken at time points of 4 hours (h), 8h, 12h and 24h. Endotoxin was intraperitoneally injected in 44 rats and IL-6 in 49 rats. After 0, 5, 10, 15, 30 and 60 minutes (min), blood was sampled. Endotoxin and IL-6 were measured using the limulus-amoebocyte-lysate (LAL) test and ELISA technique, respectively. RESULTS: No endotoxin or IL-6 was measured in the blood of controls. Plasma endotoxin and IL-6 levels were significantly high in the peritonitis groups. There was no further increase in endotoxin plasma levels after i.p. injection of endotoxin. Following i.p. injection of IL-6, there was an increase in IL-6 level over the time of sampling in the peripheral blood at 4h of peritonitis. CONCLUSION: There was a clear reduction in peritoneal resorption of endotoxin and IL-6 in this acute model of gram-positive peritonitis.

Perforated peptic ulcer: different ethnic, climatic and fasting risk factors for morbidity in Al-ain medical district, United Arab Emirates.

AIM: To evaluate risk factors, morbidity and mortality rates of perforated peptic ulcer (PPU) and to investigate factors affecting postoperative complications of PPU. BACKGROUND: The incidence of PPU has remained constant, simple closure with omental patch repair being the mainstay of treatment. PATIENTS AND METHODS: One hundred and nineteen patients admitted to Al-Ain Hospital with PPU between January 2000 and March 2004 was studied retrospectively; two with deficient data were excluded from the analysis. Logistic regression was used to define factors affecting postoperative complications. RESULTS: The mean age of patients was 35.3 years (range, 20-65). 45.7% of patients were Bangladeshi, and 85.3% originated from the Indian subcontinent. One patient, subsequently found to have a perforated gastric cancer, died. In 116 patients, 26 complications were recorded in 20 patients (17.2%). Common risk factors for perforation were smoking, history of peptic ulcer disease (PUD) and use of non-steroidal anti-inflammatory drugs (NSAIDs). A significantly increased risk of perforation was evident during the daytime fasting month of Ramadan. An increase in the acute physiology and chronic health evaluation (APACHE) II score (p = 0.047) and a reduced white blood cell count (0.04) were highly significant for the prediction of postoperative complications. CONCLUSION: Patients with dyspeptic symptoms and a history of previous PUD should be considered for prophylactic treatment to prevent ulcer recurrence during prolonged daytime fasting in Ramadan, especially during the winter time.

Laparoscopy in gastrointestinal malignancies.

This paper presents an update of the role of minimally invasive surgery (MIS) in gastrointestinal malignancy. A review of indications, surgical technique, and radicality of laparoscopy in the field of gastrointestinal cancer surgery is discussed. The feasibility and safety of laparoscopic procedures are compared with established and implemented standards in the diagnosis and treatment of oncological disorders. It is important to appreciate that only the "access" is different with all its attendant advantages. The use of laparoscopy in tumor staging and palliative and curative resection is evaluated on review of the literature, and special indications for a laparoscopic approach in gastrointestinal malignancy in different organs are discussed. In conclusion, MIS is safe and feasible, with many short-term advantages; long-term results should be further assessed in randomized controlled studies. Until the outcomes of such studies are available MIS for malignant disease should be performed by experienced surgeons in specialized centers.

Hepatocellular carcinoma directly invading the duodenum.

Recurrent gastrointestinal bleeding from hepatocellular carcinoma HCC invading the duodenum is very rare. We present a case of 50-year-old male who was admitted with a history of recurrent upper gastrointestinal tract UGIT bleeding, weight loss and anemia. The patient was known to have a chronic hepatitis C. Endoscopic examination showed grade-2 non-bleeding esophageal varices, and a large ulcerated duodenal mass partially obstructing the duodenal bulb outlet and causing recurrent UGIT bleeding. Pathological evaluation of the mass revealed HCC.

Ertapenem versus ceftriaxone and metronidazole as treatment for complicated intra-abdominal infections.

BACKGROUND: Prompt surgical intervention supplemented by appropriate antimicrobial therapy is usually required for successful treatment of complicated intra-abdominal infections. The objective of this study was to further evaluate the efficacy and safety of ertapenem relative to ceftriaxone/metronidazole as treatment for complicated intra-abdominal infections. METHODS: Adult patients with intra-abdominal infections requiring surgery were eligible for this open-label randomized trial comparing ertapenem 1 g daily with ceftriaxone 2 g daily plus metronidazole 30 mg/kg/day. The primary efficacy outcome was the clinical response rate in clinically and microbiologically evaluable participants at the test-of-cure (TOC) visit 2 weeks after discontinuation of therapy. All treated patients were included in the safety analysis. RESULTS: Participant demographics, disease characteristics, and duration of therapy in both treatment groups were generally similar. Escherichia coli was the most commonly isolated baseline pathogen, recovered in 52% of cases in each treatment group. Favorable clinical responses were achieved at TOC in 143 (96.6%) of 148 ertapenem recipients and in 146 (96.7%) of 151 ceftriaxone/metronidazole recipients. The frequencies of drug-related adverse events, most commonly nausea, diarrhea, vomiting, and elevated platelet count, were generally comparable in both treatment arms. Four ertapenem recipients (1.8%) and one ceftriaxone/metronidazole recipient (0.4%) experienced serious drug-related adverse events. CONCLUSIONS: In this study, ertapenem and ceftriaxone/metronidazole were comparably effective treatments for adult patients with complicated intra-abdominal infections.

Stromal sarcoma of the breast: a case report.

We report a case of a 36-year-old lady who presented with a huge fungating tumour that involved the entire right breast. The tumour was diagnosed histologically as undifferentiated primary stromal tumour of the breast with axillary lymph node metastasis. We review the literature of this rare malignant tumour. Stromal sarcomas of the breast lack epithelial participation, and diagnosis of these tumours can be difficult. Genome-wide expression profiling is currently used to determine the cell of origin of most sarcomas. Surgery offers the best therapeutic option. Adjuvant radiotherapy is not very beneficial, while chemotherapy has, to date, no established role in the management of this disease. The prognosis is dismal for patients with lymph node involvement. The size of the tumour has a lesser bearing on outcome.

[Life-threatening gastrointestinal bleeding related to the treatment of strongyloidiasis hyperinfection in an immunocompromised patient]. / Eletet veszélyeztetó gastrointestinalis vérzés strongyloides hiperinfekció kezelése kapcsán immunszupprimált betegben.

The clinical course and sequel of the life-threatening gastrointestinal (GI) bleeding during the treatment of strongyloides helmintic hyperinfection induced by immunosuppression in a patient with multiple myeloma is presented. A 55-year old male patient was diagnosed with strongyloides infection with stool analysis and intestinal biopsy shortly after his combined chemotherapy for myeloma. He was commenced on albendazole anthelmintic therapy. However, after initiation of the treatment he suffered life-threatening GI bleeding. Repeated endoscopies, including intraoperative enteroscopy, concluded to diffuse multifocal intestinal bleeding. The patient required huge amounts of red blood cells and plasma transfusions and correction of haemostasis with recombinant activated factor VII. Abdominal aorto-angiography showed numerous microaneurysms ("berry aneurysms") in the superior and inferior mesenteric arteries' territories. While the biopsy taken prior to the treatment with albendazole did not show evidence of vasculitis, the biopsy taken after initiation of therapy revealed leukoclastic aggregations around the vessels which was also consistent with vasculitis. These findings suggest that--in addition to direct destruction of the mucosa-vasculitis could be an important additive factor to the massive GI bleeding during the anthelmintic treatment. This might result from substances released by the worms that have been killed with anthelmintic drugs. Current guidelines advise steroids to be tapered and stopped in case of systematic parasitic infections as they reduce immunity and precipitate parasitic hyperinfection. In our pinion, steroid therapy might be of value in the management of strongyloides hyperinfection related vasculitis--in addition to the specific anthelmintic treatment. Indeed, steroid therapy of vasculitis with other means of supportive care yielded in sequel of the bleeding and in recovery of the patient.

Superior mesenteric vein thrombosis complicating appendicular masses.

Mesenteric vein thrombosis (MVT) is rare. Its diagnosis is usually difficult and delayed. Herein, we report 2 patients who developed MVT as a complication of an appendicular mass. One of them had appendectomy and developed fever 10 days postoperatively. The other was treated conservatively. An abdominal computerized tomography (CT) scan with intravenous contrast was helpful in diagnosing the superior MVT in both patients, which were not suspected. Intravenous contrast should be used when performing CT of an appendicular mass. Special interest should be directed at studying the superior mesenteric vein. Early diagnosis of our patients helped to start early medical treatment with anticoagulation.