Iatrogenic esophageal perforation in the neonate.

BACKGROUND: Esophageal perforation is uncommon and often iatrogenic. AIM: To report a neonatal case of esophageal perforation. CASE: A premature newborn boy was admitted with a diagnosis of oesophageal atresia after several unsuccessful attempts to insert an orogastric tube. A chest x-ray showed a "high pouch" with a gasless intestine. At operation, no atresia was found and a large traumatic perforation of the lower cervical segment was identified, requiring cervicotomy and primary closure. Oral feeding was started after 3 weeks. As a result, nosocomial sepsis occurred, causing death in the third month after surgical treatment. CONCLUSION: Oesophageal perforation in the neonate is often iatrogenic and may mimic oesophageal atresia. The authors highlight the importance of early diagnosis and management.

[SSRIs and pregnancy: a review of the literature]. / ISRS et grossesse: revue de la littérature.

OBJECTIVE: A review of the consequences of maternal depression on fetal and infant development and the risk and benefits of SSRI use. METHOD: We have reviewed the literature published on PubMed between January 1980 and February 2009 using the following keywords: SSRI, depression, pregnancy, abnormality, teratogenic effect. RESULTS: Pregnancies complicated by the onset or recurrence of a major depressive disorder constitute a complex medical situation. The management of such situations is based on the principle of avoiding, as far as possible, the exposure of the developing foetus to both the maternal illness and the potential teratogenic effects of psychotropic drugs. Epidemiological studies show that maternal depression is a very frequent disease: 10 to 16% of pregnant women fulfill major depressive disorder diagnostic criteria and 15% suffer from postpartum depression. The consequences of such exposure on fetal and infant development are so harmful that a pharmacological treatment is highly recommended. Nowadays, the information available on the safety of SSRI use in pregnancy is abundant and these molecules are probably the most studied drugs in pregnant women. Their beneficial effects largely prevail over their potential fetal/neonatal risks and it is unlikely that any marked teratogenic effect occurs, with the possible exception of an increased risk for cardiovascular defects after maternal use of paroxetine. However, transient neonatal symptoms are common after SSRI use in late pregnancy. These include transient autonomic, gastrointestinal, somatic, and clinical respiratory manifestations in the immediate neonatal period. CONCLUSION: Treatment of maternal depression during pregnancy and immediate neonatal period is uniformly recommended despite the potential side effects on the fetus and newborn. With a possible exception for paroxetine, maternal treatment with SSRIs during pregnancy is not associated with significantly increased risks of congenital defects.

Seroprevalence of hepatitis C virus (HCV) infection among blood donors: a hospital-based study.

Insofar as chronic hepatitis C virus (HCV) infection in many individuals is asymptomatic, and as the prevalence of antibodies to hepatitis C virus (anti-HCV) among blood donors in Lebanon is scarce, this study addressed the prevalence of anti-HCV in 5,115 blood donors. Data obtained were compared to other world regions. Of the blood donors screened, 57 were initially tested positive or doubtful for anti-HCV Ab. Subsequent testing by two-third generation enzyme immunoassays confirmed that, of the 57 initially tested positive/doubtful, only 18 were positive for anti-HCV giving a prevalence rate of 0.4%. While there was no difference in HCV prevalence with respect to age or gender, a higher rate was seen in non-Lebanese compared to Lebanese subjects (3.4% vs 0.3%, P < 0.001). These results demonstrate a low prevalence of HCV infection among Lebanese blood donors, which was comparable to those established for western countries.

Seroprevalence of hepatitis C infection among health care personnel in Beirut, Lebanon.

BACKGROUND: Health care workers are at risk of contracting hepatitis C virus (HCV) infection more than the general population, and chronic HCV infection may be asymptomatic. Therefore, the purpose of this study was to determine the seroprevalence of HCV among health care workers at St Georges-Orthodox Hospital, the first study done for a major teaching hospital in Lebanon. METHODS: Health care personnel at St Georges-Orthodox Hospital, Beirut, were offered anonymous testing for anti-HCV antibody. Seroprevalence rates of health care personnel were compared with the rates of blood donors screened during the same year. RESULTS: Of the 502 persons screened, 13 (2.60%) initially tested either positive or doubtful-positive by the SM-HCV rapid test; 2 (0.4%) were confirmed positive by 2 commercial enzyme-linked immunosorbent assay kits and reverse transcriptase-polymerase chain reaction. This prevalence rate was comparable with the rate obtained for blood donors (n = 600) during the same period. CONCLUSION: The seroprevalence of HCV infection among health care workers at St Georges-Orthodox Hospital was similar to the rate observed in local blood donors, which suggests that the occupational risk of HCV infection was low.

Value of duodenal endoscopic markers of villous atrophy.

UNLABELLED: Several endoscopic aspects of duodenal mucosa have been described in patients with villous atrophy (VA) and celiac disease. We assessed the accuracy of three endoscopic markers in patients referred for duodenal biopsy. METHODS: From January 1992 to June 2000 all patients undergoing upper gastrointestinal (UGI) endoscopy by a single operator (n = 4102), had the second part of the duodenum examined, without any magnification technique or addition of vital dye staining, for the presence of three markers of VA, (1) reduction or loss of Kerkring's folds, (2) scalloped configuration of the duodenal folds, and (3) mosaic appearance of the mucosa. Biopsy samples were taken from those in whom the mucosa was abnormal (n = 51), and from those in whom it was normal but where biopsy was indicated (n = 230). RESULTS: None of the 230 endoscopically normal controls had VA. Seven out of 51 patients (14%) with an abnormal mucosa had a normal histology, the remaining 44 (86%) had some degree of VA confirmed at histology, partial VA in 11 patients (25%) and subtotal or total VA in 33 patients (75%). 63% of the patients with only one endoscopic marker had VA confirmed at histology whereas the coexistence of more than one marker was always associated with histological villous atrophy. The overall sensitivity, specificity, positive and negative predictive values of the endoscopic markers were respectively, 100%, 97%, 86%, and 100%. CONCLUSION: The appearance of the second part of the duodenal mucosa as assessed during routine UGI endoscopy, is a sensitive and specific indicator of the presence of VA on biopsy, and should alert the endoscopist to the possibility of a celiac disease.

Transfusion associated graft versus host disease in immunocompetent patients. Report of two cases.

Transfusion graft versus host disease (TGVHD) in immunocompetent patients is a recently recognized disease, reported mainly after open heart surgery, and almost always fatal. We report two cases of TGVHD in immunocompetent patients after open-heart surgery. The disease is characterized by the occurrence of fever, skin rash, liver failure and pancytopenia. Preventive measures include exclusion of first- and second-degree relatives as blood donors, and/or irradiation of blood to be transfused.

Endoscopic patterns of primary gastric MALT lymphoma.

Primary low grade B-cell lymphoma of the mucosa associated lymphoid tissue (MALT), is an uncommon malignancy with a prolonged period of localized disease, and a possible transition to a high grade MALT lymphoma. The endoscopic diagnosis is often difficult, because of the various macroscopy patterns. The endoscopic aspects seen in 14 patients diagnosed and treated for primary gastric MALT lymphomas, were reviewed. Four main patterns were recognized: 1/Large ulcerations (n = 6, 42.9%), 2/Polypoid lesion (n = 2, 14.3%), 3/Gastritis with small ulcerations (n = 4, 28.5%), and 4/Atypical mucosal relief (AMR): erythema, nodularity, edematous or infiltrated folds (n = 2, 14.3%). In 10 cases (71%) AMR was associated with another endoscopic pattern. Histologically the tumors were of low grade (n = 11) and high grade (n = 3). On initial endoscopy a diagnosis of malignancy was done in 6 out of the 7 patients (85.7%) with large ulcers and the large polypoid mass; in contrast, an adequate endoscopic diagnosis was made in only 3 out of the 7 patients (42.8%) with ulcerative gastritis, AMR, and the small polypoid lesion. The endoscopic aspect of the latter group, representing 50% of all patients and 63.6% of the group with low grade MALT lymphomas, was indistinguishable from a benign lesion. Therefore it is important to be aware of this entity and perform biopsies in every patients with abnormal endoscopic findings.

Prevalence of malnutrition in general surgical patients.

The possibility of protein-calorie malnutrition (PCM) was studied on one hundred consecutive patients admitted to the department of surgery at the Saint Georges Hospital, Beirut, during the months of April and June 1991, regardless of age, sex and socio-economic status. Data was completed on 94 of those cases. Multiple parameters were studied, including measurements of triceps and subscapular skinfold thickness, mid-arm muscle circumference, percent weight loss, creatinine height index, serum albumin and transferrin levels and total lymphocyte count. We found a prevalence of 81%, 65%, 53% and 31% of PCM, if one, two, three or at least four abnormal parameters are used respectively, to assess malnutrition. Defining malnutrition as the presence of at least three abnormal parameters, we conclude that 53% of the patients, on admission to the department of surgery, had evidence of PCM. Further studies are required to assess the impact of this prevalence on length of stay, morbidity and mortality.

Unusual skin pigmentation in a patient with human immunodeficiency virus (HIV) infection.

Diffuse addisonian hyperpigmentation in a male patient with acquired immunodeficiency syndrome related complex (ARC) is described. The etiology of pigmentation in this patient remains obscure but is most probably related to the H.I.V. infection. Other causes of addisonian hyperpigmentation are considered less likely.

[Muscular manifestations in periodic disease]. / Les manifestations musculaires de la maladie périodique.

Between 1976 and 1983, the authors studied 50 new patients affected with periodic disease. 16 of them-mean age: 29-presented muscular manifestations. They may be grouped into two clinical aspects: muscular pain and contractures. The authors consider that these symptoms, first described in 1945, are an inherent part of the clinical picture of the disease. They discuss their relationship with periarteritis nodosa and remind the fact that their pathogenesis remains unknown.