changing pattern of upper gastro-lntestinal lesions in southern Saudi Arabia: an endoscopic study

Dyspepsia is a common gastrointestinal disorder and is the most common indication for upper gastrointestinal endoscopy [UGIE]. In recent years, it has been observed in several centers that there is a change in the causes of dyspepsia as revealed by UGIE. Our main objectives were: [1] To study the pattern of upper gastrointestinal pathology in patients with dyspepsia undergoing upper endoscopy; [2] Compare that with the pattern seen 10-15 years earlier in different areas of KSA. Retrospective study of all UGI endoscopies performed at Aseer Central Hospital, Abha, Southern Saudi Arabia during the years 2005-2007 on patients above 13 years of age. Patients who underwent UGIE for reasons other than dyspepsia were excluded. The analysis was performed using the SPSS 14 statistical package. A total of 1, 607 patients underwent UGI endoscopy during the three-year study period [age range, 15-100]. There were 907 males [56.4%] and 700 female [43.6%]. Normal findings were reported on 215 patients [14%] and the majority had gastritis [676 = 42%], of whom 344 had gastritis with ulcer disease. Moreover, 242 patients [15%] had gastro-esophageal reflux [GERD], with or without esophagitis or hiatus hernia. Also, a total of 243 patients had duodenal ulcer [DU] [15%] while only 12 had gastric ulcer [0.7%]. There is clear change in the frequency of UGIE lesions detected recently compared to a decade ago with an increasing prevalence of reflux esophagitis and hiatus hernia. This could be attributed to changes in lifestyle and dietary habits such as more consumption of fat and fast food, increased prevalence of obesity, and smoking. These problems should be addressed in order to minimize the serious complications of esophageal diseases

Total intravenous versus inhalational anesthesia for one lung ventilation during thoracic surgery

This study was designed to compare the effect of intra-venous [iv] anesthetic technique using propofol and inhalation anesthetic technique using enflurane on oxygenation and haemodynamics before, during and after one lung ventilation [OLV] in patients undergoing lung surgery. Forty patients undergoing elective thoracotomy for lung surgery with periods of OLV were included in this study. The study investigated the cardiovascular effects and oxygenation status before, during [at selected intervals] and after OLV in 2 groups of patients anaesthetized with either propofol, used for induction and maintenance of anesthesia, or enflurane used for maintenance of anaesthesia. Propofol O[2] anesthesia induced a decrease in HR and MAP and a rise in PCWP and CVP. Enflurane in O[2] for maintenance of anesthesia induced mostly a moderate rise in HR, less decrease in MAP and a rise in PCWP and CVP. The decrease in MAP found in both groups was associated with greater decrease in SVRI in propofol group than enflurane group. The PVRI was increased in both groups of patients, especially in late stages of OLV in propofol group. The CI was decreased in both groups. SVI was found to be increased in most periods of OLV in both anesthesized groups. Both groups had elevated shunt fractions at baseline, no changes during two lung ventilation [TLV], while dynamics and respiratory variables were similar for the two groups. We concluded that total intravenous anesthesia technique [TIVA] with propofol and fentanyl is suitable for major thoracic surgery. It provides smooth and easily controllable anesthetic with stable blood pressure and pulse rate even during the period of one lung ventilation. In spite that the shunt fraction was increased in both groups, the present results suggest that oxygenation may be maintained to a greater degree with propofol anesthesia as shunt fraction was less, which means that propofol anesthesia has a relatively less influence on HPV. The majority of the patients awake quickly and were able to cough and sigh on command

Early nutritional intervention for criticality ill patients

To determine whether nutrient intake by early enteral nutrition [EN] with parenternal nutrition [PN] improves levels of retional-binding protein [RBP] and prealbumin and if it has effect on the occurrence of complication, length of stay in intensive care unit [ICU] and the need of ventilatory and circulatory support in ICU patients.48 patients were included in the study classified into two equal groups [24 patients each] received either EN plus PN [treatment group] or EN plus placebo [placebo group] for 7 days after initiation of nutritional support. There were eight patients with early drop out, however these patients excluded from the analysis and the study. There was a significant improvement in the patients as indicated by significant decrease in the mean of APACHE II score, with significant increase in the mean of Glasgow Coma Score [GCS] in both groups. Retional-binding protein [119.18 vs 73.05 mg/1] [P < 0.001] and prealbumin [346.81 vs 257.24 mg/l] [P < 0.05] increased significantly in the treatment group from day 0 to day 7. There was no difference between the two groups regarding the occurrence of multiple organ failure, or the need of ventilatory support, or the length of stay in ICU but, the length of stay in the hospital was significantly shorter [11.05 vs 14.4 days] [P < 0.05] and the need of the inotropic support also was significantly lower [2.22 vs 3.43 days] [P < 0.001] in the treatment group. This study showed that the cost of combined nutrition / patient / day was significantly high [230.8 vs 96.1 pounds/day] [P < 0.0001] in the treatment group than in the placebo group. In the critically ill patients, starting early combination of enteral and parenteral nutrition is safe, effective and has a beneficiel effect on correction of nutritional parameters as retional binding protein and prealbumin but it has no effect on the length of stay in the intensive care unit or the occurrence of complication, also it has no effect on the need of ventilatory support

Comparative study between propofol and methohexital during induction and first hour of recovery

Anesthesia and recovery during the first hour after propofol and methohexital anesthesia for dilatation and curettage [D and C], lasting about 12 min. were compared, the latter in a double-blind manner by means of psychomotor tests [coin counting and continuous auditory reaction time]. Muscle movements and hiccups were seen significantly more frequently during methohexital inductions. No differences were seen regarding pain at the site of injection or apnea between the groups. At 15 min after the last dose of anesthetic, recovery after methohexital was ahead of that after propofol, but after one hour, psychomotor performance was better in the propofol group. Side-effects during recovery were few, and incidence did not differ significantly. Although the difference in reaction time test was significant, it was hardly large enough to be of any clinical importance. Both drugs are useful for brief day-case-anesthesia, but smoother induction gives propofol on edge over methohexital

Effect of indomethacin on human gingival mast cells: a histologic study

The tested group having severe gingival inflammation at the beginning of theresearch, received indomethacin [END] for 2 weeks period. The resultsrevealed that the average number of the mast cells per microscopic field was 5.17 +/- 2.11. The difference between this group and control subjects wasstatistically significant [P < 0.05 and 0.01]. The mast cells exhibitedbluish-violet color, large size and less degranulation process. While, thecontrol group recorded a mean of 1.67 +/- 0.93 mast cells per microscopicfield. Mast cells exhibited reddish-violet metachromasia and small size, thedegranulation was common finding. In conclusion, the increased mast celldensity in tested group [END group] as well as a decrease of mast celldegranulation could explain the potent effect of indomethacin on the gingivalinflammation. Furthermore, the decreased mast cell counts in control group could reveal the significance of important mediators released by those cellsand their effect on the integrity of the gingival connective tissue

Clinical evaluation of the systemic use garline as a suspected model for control of periodontal disease

This study was done on 30 patients, of both sexes, suffering fromperiodontal disease. The purpose was to examine the systemic effect ofGarline drug as an adjunct to local periodontal therapy for the management ofinflammatory periodontal disease. The patients were divided into 4 groups :Group I included patients receiving Garline capsules and submitted to localperiodontal treatment, group II included patients received Garline capsules only, group III included those submitted to local therapy plus placebo capsules and group IV included patients received placebo capsules alone [control]. Gingival index, plaque index, pocket depth and attachment level measurements were recorded. The clinical and statistical data obtained from the applied study showed that the administration of Garline capsules combined with local periodontal treatment improved the gingival condition more significantly than the other groups

Mast cells in gingivae of epileptic patients receiving epanutin

Twenty-five male patients, ranging in age from 14 to 24 years were divided into 10 epileptic patients receiving Epanutin for 10 months in association with local factors [plaque and calculus], 10 epileptic patients receiving Epanutin without local irritant factors, and 5 volunteers with chronic gingivitis and free from any systemic disease [control group]. Analysis of the results revealed that in the presence of local irritants, both gingival inflammation and enlargement were apparent, compared to the noninflamed gingival group with Epanutin therapy. As regards the mast cells, they decreased in number and were most commonly degranulated. In noninflamed gingival group of epileptic receiving Epanutin, the mast cells appeared typical in shape, no degranulation and the number was decreased as compared to control group. These findings were interpreted as a direct effect of Epanutin on gingival mast cells augmented by irritant factors with resultant degranulation and elaboration of active cytoplasmic components

Human salivary glands in oral lichen planus

Twenty cases of oral lichen planus were collected from El-Hode El-Marsode Hospital at Cairo, Egypt. Biopsies were obtained from the lip and buccal mucosa to investigate the histopathological changes in the minor salivary gl and s. Acinar atrophy, ductal dilatation and periductal chronic inflammatory cells were demonstrated. Ranula, sialolithiasis and huge dilation of the blood vessels had not been previously reported in any diseases of salivary gl and s whether of primary or secondary involvement