Familial achalasia in children.

Achalasia is rare in the pediatric age group and in most cases it is idiopathic with no family history. Familial achalasia is very rare. This report describes two families with achalasia: in one, six children were affected while in the other a brother and a sister had Allgrove's syndrome (triple-A syndrome consisting of achalasia, adrenal insufficiency, and alacrima). Familial achalasia suggests that it is hereditary and may be transmitted as an autosomal recessive trait. The management of achalasia in children is still controversial. With the recent advances in minimal invasive surgery, laparoscopic Heller's myotomy is the procedure of choice in the management of achalasia in children.

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.

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.

Helicobacter pylori in sleeve gastrectomies: prevalence and rate of complications.

HELICOBACTER PYLORI IN SLEEVE GASTRECTOMIES: Prevalence & Rate of Complications. Prevalence of Helicobacter pylori has not been established in sleeve gastrectomy specimens and yet initial observations indicate that it is significant. The aim is to determine prevalence of Helicobacter pylori and correlate with rate of post-operative complications. A total of 89 Sleeve gastrectomies were identified. Pathology reports and slides were re-examined. Warthin Starry special stain and clinical history were obtained. 38 cases were Helicobacter pylori positive (44%). 33 (39%) cases initially reported negative for Helicobacter pylori on routine hematoxylin and eosin stained slide; were positive when Warthin starry stain was employed. The presence of neutrophils in tissue was strongly associated with presence of Helicobacter pylori on Warthin stain (p<0.001). Post-operative complications were observed in 8 patients (9%). Complications were not significantly associated with Warthin-Starry special stain status (p=0.98).

Factors affecting anatomical region of injury, severity, and mortality for road trauma in a high-income developing country: lessons for prevention.

OBJECTIVES: To study the factors affecting anatomical region of injury, severity, and mortality among road users in United Arab Emirates so as to improve preventive measures. METHODS: Data of the Trauma Registry of Al Ain city were collected prospectively over 3 years (2003-2006) at the main trauma hospital. For traffic injuries, the following were assessed: gender, nationality, road user type, anatomical region(s) of injury, systolic blood pressure on admission, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and mortality. Analysis included frequencies, cross-tabulations, and logistic regression. RESULTS: There were 1070 patients, 89% male, 25% UAE nationals, and with a mean age of 31 years. Expatriates, mainly from non-Arabic speaking, low-income countries, accounted for 88% of injured pedestrians, whilst nationals were overrepresented among vehicle occupants (29%), and motorcyclists 37%. Injuries of the extremities and head were frequent among pedestrians, motorcyclists, and bicyclists, whilst head and spine injuries were most common among front and rear vehicle occupants and drivers. The median ISS was five for pedestrians and four for all other road user types, including rear vehicle occupants. The mean hospitalisation was 9.7 days; 13% of patients were admitted to ICU with mean stay of 6.5 days. Overall mortality was 4%; pedestrians accounted for 61% of deaths. Predictors of mortality were GCS (p<0.001), ISS (p<0.01) and systolic blood pressure on admission (p<0.03). CONCLUSIONS: Head injury was a major factor affecting mortality, followed by injury severity and hypotension. To reduce injury incidence and severity, legislation and education are needed to ensure use of seat belts by all vehicle occupants including rear passengers, high-visibility devices by other road users, helmets by motorcyclists and bicyclists, protective clothing and boots for motorcyclists, and traffic engineering for pedestrians.

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.

Epidemiology of geriatric trauma in United Arab Emirates.

The mechanisms and outcome of trauma in hospitalized elderly patients were studied. The data of Al-Ain Hospital Trauma Registry were prospectively collected over a period of 3 years (2003-2006). All elderly trauma-patients above 60 years who were admitted to surgical ward or who died on arrival were studied. Demography of patients, mechanism of injury, Injury Severity Score (ISS), hospital stay and mortality were analyzed. There were 121 patients (70 males and 51 females). Mean (range) age was 69 years (60-100), 42% were United Arab Emirates (UAE) nationals. The two most common mechanisms of injury were falls (55%) followed by road traffic collisions (RTC) (32%). The median (range) ISS of the group was 5 (1-34). The ISS median (interquartile range) of falling down, RTC, and fall from height were 4 (4-9), 6 (4-10), and 8 (5-9), respectively (p=0.31). Forty-one percentage of injuries occurred at home. The mean (range) hospital stay was 12.4 (1-150) days. Six patients (5%) were admitted to the intensive care unit. Overall mortality was 6% (7 patients), of whom 5 were pedestrians hit by cars. We concluded that low-energy trauma from falls was the most common cause of injury in the elderly. Mortality was high mainly from pedestrian injuries.