An experience of ultrasound-guided hydrostatic reduction of intrussusception at a tertiary care centre.

BACKGROUND: Intussusception is an important and one of the most commonly encountered diagnoses of intestinal obstruction in the paediatric age group. Ultrasound-guided hydrostatic reduction is an effective, nonoperative treatment modality for this condition and is associated with a high success rate. In addition, it is simple and safe as the entire procedure is carried out with real-time ultrasound, without the hazard of radiation. The aim of this study was to evaluate the effi cacy and safety of ultrasound-guided hydrostatic reduction in the management of intussusceptions in the paediatric age group. METHOD: A case study was carried out on 89 patients diagnosed with intussusception using high-resolution ultrasonography over a period of two years, spanning February 2012 to January 2014. Ultrasound-guided hydrostatic reduction was performed in 78 of these patients, and 11 patients were excluded owing to clinical contraindications. Follow-up ultrasound was performed after 24 hours to rule out recurrence. RESULTS: The disease was most prevalent in the age group 6-24 months. The ileocolic type was the most common. Mean duration (hours) was 17.02 ± 20.81 for time to presentation. Complete therapeutic reduction was achieved in 70 of the 78 cases, with a success rate of 90%. Two recurrences occurred in the following 24 hours, which were successfully reduced on the second attempt. Complications and mortality did not occur secondary to the procedure. CONCLUSION: Our study found that ultrasound-guided hydrostatic reduction is a simple, safe and effective nonoperative treatment for intussusceptions in the paediatric age group, and should be the fi rst line of management in appropriate patients.

Methylation profile of promoter region of p16 gene in colorectal cancer patients of Kashmir valley.

Colorectal cancer (CRC) commonly known as bowel cancer is the third most common cause of cancer-related deaths in the western world and has been reported to show geographical variation in its incidence. Cancer development and progression is a complex process dictated by changes in expression and regulation of various genes which include tumor suppressor genes, DNA repair genes, translation regulatory genes and others. The aim of this case control study was to analyze the promoter hypermethylation at CpG islands of p16 gene in CRC patients among the Kashmiri population and co- relate it with expression pattern of p16. Genomic DNA was isolated from surgically resected tumor and adjacent normal samples and was modified using bisulphite modification kit. Methylation-specific polymerase chain reaction (PCR) was setup for the analysis of the promoter hypermethylation of p16 gene. The epigenetic analysis revealed that unlike other high risk regions, Kashmiri population has a different promoter hypermethylation profile of p16 gene as 66 percent of the cases showed p16 promoter hypermethylation in comparison to 20 percent of the normal cases which also showed promoter hypermethylation of p16 gene. The association of promoter hypermethylation with colorectal cancer was found to be significant (P=0.0006). Occurrence of p16 promoter hypermethylation was found to be unequally distributed in males and females with more frequency in males than in females but the difference was not statistically significant(P =0.7635). Similarly, frequency of p16 promoter hypermethylation was found to be certainly higher in Stage III/IV (83.33 percent) compared to Stage I/II (56.25 percent) but the difference was not statistically significant (P =0.0673). Also, the degree of p16 promoter hypermethylation increased with the increasing severity of the lesion but the difference was not again statistically significant (P =0.6145). Promoter hypermethylation correlated with the decrease in expression of the p16 gene in CRC patients leading to the diseased phenotype. These results suggest that p16 aberrant promoter hypermethylation in Kashmiri population contributes to the process of carcinogenesis in CRC and may be developed into a valuable tool for CRC diagnosis at early stages.

Benign intermittent gastric outlet obstruction in an elderly: endoscopic management and brief review.

We describe the clinical scenario in an 80 year old female who presented with history of epigastric discomfort and postprandial fullness of three weeks duration without any alarming symptoms. On upper GI endoscopy she was found to have gastric polyp with a long stalk which was partially obstructing her pyloric ring giving rise to features of intermittent gastric outlet obstruction. Polypectomy was done with complete relief of symptoms. She is following our clinic for last 6 months now. Although possibility of malignant etiology in gastric outlet obstruction ranks high in the elderly some patients are lucky to have a benign cause as the index case. Report of the case and brief review is presented.

Benign Intermittent Gastric Outlet Obstruction in an Elderly: Endoscopic Management and Brief Review

We describe the clinical scenario in an 80 year old female who presented with history of epigastric discomfort and postprandial fullness of three weeks. duration without any alarming symptoms. On upper GI endoscopy she was found to have gastric polyp with a long stalk which was partially obstructing her pyloric ring giving rise to features of intermittent gastric outlet obstruction Polypectomy was done with complete relief of symptoms .She is following our clinic for last 6 months now. Although possibility of malignant etiology in gastric out let obstruction ranks high in the elderly some patients are lucky to have a benign cause as the index case. Report of the case and brief review is presented

Malignant melanoma of the skin: a case report from the eastern region (dammam central hospital), saudi arabia and epidemiological review.

Worldwide malignant melanoma is the commonest tumor of the skin, though it occurs in many other organs. It is a serious disease, the prognosis of which is poor if not detected and treated early. The disease is on the increase in many countries e.g. USA,1 England and Wales,2 Australia,3 and many parts of the world.4-6 Saudi Arabia is a vast country which is undergoing rapid development with a changing social and economic environment. To the best of our knowledge, not many studies or reports of malignant melanoma have issued from the Eastern Region. It is therefore, important to report this case and review the incidence of the disease.

[Development and clinical application of an expert system for supporting diagnosis of 201Tl stress myocardial SPECT].

A consultation expert system which supports our computer aided reporting system was developed. The system was used for the evaluation of the two dimensional polar (bull's eye) display of 201Tl myocardial SPECT. The system consists of patients management (PM) and consultation expert systems (ES). The former is connected to image processors coupled with scinticameras. The bull's eye display of myocardial SPECT is transferred from image processor to the data base of PM. When inference request is made, the feature extraction program extracts information on localization, extent and severity of focal defects comparing count-rates pixel by pixel with the reference obtained from seven normal controls. The inference engine is activated to determine presence of focal defects utilizing diagnostic rules in the knowledge base. The results are sent back to PM and reported with the probability of assurance. Fifty eight patients with old myocardial infarction (OMI), angina pectoris (AP) and other diseases as well as normal controls were included in the study. The decision for presence or absence of focal defects by ES agreed with that by nuclear physicians (NP) in 301 segments among 330 (91%) in stress images. The presence of redistribution in delayed images agreed in 43 segments among 67 (64%). Image interpretation by ES agreed well with that of NP in patients with OMI (19/20) and AP (9/11). Seven were interpreted as normal by both ES and NP. The system is useful, as it provides NP with complementary and supportive information applicable to decision making and reporting. Further clinical experiences can improve knowledge base for better ES function.

Anterior seromyotomy with posterior truncal vagotomy in chronic duodenal ulcer.

Anterior seromyotomy with posterior truncal vagotomy was carried out on 25 patients with chronic duodenal ulcer to evaluate its effectiveness as an acid reducing procedure. There was a 76.7% and 76.8% reduction in basal and maximal acid output respectively (augmented histamine test). Twenty-three patients were asymptomatic at 4-6 years' follow-up, while two patients had delayed gastric emptying not necessitating reoperation. There was no mortality. This procedure is a reasonable alternative to highly selective vagotomy.

Primary spinal extradural hydatid cyst.

We report a rare case of spinal cord compression caused by a primary extradural hydatid cyst.

Automated body contour detection in SPECT: effects on quantitative studies.

To perform accurate in vivo quantitation by single photon emission computed tomography, we have developed a new method for detecting body contours for the correction of tissue attenuation. Our method can rapidly derive the best fit contours throughout the body by using the measured axial length of the patient body and Fourier filtering the detected contours which are defined by a unique bit-plane algorithm. We have also evaluated the effects of the body contours on the reconstructed images by using various attenuation correction techniques including a precorrection method (Sorenson, 1974), a postcorrection method (Chang, 1978), a weighted backprojection method, and a radial post correction method (Tanaka, 1983 and 1984). Counts in the specified region-of-interest in phantom images reconstructed by the radial postcorrection, weighted backprojection, and postcorrection methods were more strongly affected by inaccurately detected contours than were counts derived from images reconstructed by the precorrection method.