Full length migration of plastic biliary stent into the left lobe of liver and its endoscopic retrieval

An elderly female was admitted with obstructive jaundice, secondary to an impacted 1.7 cm size stone in distal CBD. Cholangiogram obtained during ERCP revealed dilated biliary system with large, immobile stone at the lower end of CBD. A large size sphincterotomy was performed and stone extraction using biliary balloon / dormia basket attempted which was unsuccessful as the stone was impacted in distal CBD. Therefore, a plastic biliary stent of 9 cm/8.5 french size was inserted successfully to secure the biliary drainage. Patient improved clinically and discharged home on ursodeoxycholic acid. Four weeks later, she presented to emergency department with signs of cholangitis. An emergency ERCP was performed. The stent had migrated up completely into the left intra hepatic duct. In this session, the stone was extracted and biliary drainage secured. Migrated stent was removed later on by another ERCP procedure

Accuracy of endoscopic ultrasound guided fine needle aspiration biopsy in diagnosis of mediastinal and pancreatic pathology at King Hussein medical centre 2003-2006

To evaluate the sensitivity, specificity and accuracy of endoscopic ultrasonography guided fine-needle aspiration biopsy [EUS-FNAB] of lymph nodes in mediastinal, intra abdominal and pancreatic lesions. Sixty-four consecutive patients with mediastinal lymphadenopathy, pancreatic lesions and intra abdominal lymphadenopathy were examined by EUS+FNA at King Hussein Medical Centre, Amman, Jordan between March 2003 and April 2006. Twenty five patients were examined for mediastinal lymph nodes, 37 for pancreatic lesions and two for abdominal lymph nodes. Our patients were 40 men and 24 women with average age between 40 and 70 year. Five patients were excluded from the study; 4 men and 1 woman because of inadequate sample all of them from pancreatic lesion. The study was performed to obtain primary diagnosis, final diagnosis was based on clinical follow up, cytology and/or surgical results. The endoscopic ultrasound guided fine needle aspiration biopsy of mediastinal nodal and pancreatic lesions were highly sensitive and specific as primary diagnosis procedures, and to differentiate between benign and malignant lesions with overall accuracy of 91.5%, sensitivity of 85.3% and 100% specificity. Regarding the lesion type; the sensitivity, specificity, accuracy, negative predictive value and positive predictive value were 92.8%, 100%, 96%, 91.6% and 100% for mediastinal lymph node; 80%, 100%, 88%, 77.7% and 100% for pancreatic lesion respectively. Primary diagnosis of malignancy was obtained by endoscopic ultrasound guided fine-needle aspiration biopsy in 49% [29/59] of patients with clinically suspicious lesion. The accuracy and sensitively for pancreatic lesion is lower than that for lymph node. No complications were reported in our study [this could be due to small sample size]. Endoscopic Ultrasound Guided Fine-Needle Aspiration Biopsy [EUS-FNAB] is safe, minimally invasive and can readily obtain adequate tissue specimens for cytopathological diagnosis, moreover it provides accurate diagnosis of medastinum, pancreatic cancer and differentiate malignant from benign lesions

Chest infection in kidney graft recipients

To estimate the incidence of chest infections in renal allograft recipients, the mortality of lung infections, the incidence of Tuberculosis, its common presenting features, and determine significant risk factors for such infections. Over an eighteen month period [January 2001 to July 2002], 100 kidney graft recipients were checked for any past or present history of chest infection. All the recipients acquired their graft from living related or unrelated donors. The study was conducted in Al-Shaheed Adnan Hospital Centre for kidney disease and transplantations in Medical city, Baghdad Teaching Hospital and Al-Karama Teaching Hospital. Statistical analyses were carried out using Chi square test and Yate's correction wherever needed. A P value of less than 0. 05 was taken as significant. Bacterial pneumonia was the commonest pulmonary infection [n=13, 32.5%] followed by the probable acute viral bronchitis [n=10, 25%], pulmonary tuberculosis [n, 22.5%] and fungal infection in five [n=5, 12.5%], nocardiosis in two and candidacies in three recipients. The mortality from chest infections including pulmonary tuberculosis in renal allograft recipients was seven [17.5%] recipients. Pulmonary tuberculosis should be included in the differential diagnosis of infections causing fever of unknown origin in the renal transplant patients, especially in endemic areas. Leucopenia and diabetes mellitus were significant risk factors for serious pulmonary infections Unrelated donor is also a risk factor for serious post renal transplant recipient pulmonary infections including tuberculosis which presents with high grade intermittent fever

Treatment of primary atrophic rhinitis with intranasal honey spray

Atrophic rhinitis is a chronic nasal disease characterized by progressive atrophy of the mucosa and underlying bone of the turbinates and the presence of a viscid secretion which rapidly dries and forms crusts which emit a characteristic foul odor sometimes called ozaena; there is abnormal patency of the nasal passages. The study was conducted on 32 patients with age range [14- 30] years, all patients included in this study suffered primary atrophic rhinitis with the classic symptoms of nasal crusts, ozenea and roomy nose, all were subjected to history taking, endoscopic examination of the nose and a histopathological examination of a specimen obtained from the inferior concha, and VDRL testing prior to therapy. Honey sprays were prepared by the patient daily as a solution of 2:1 in distilled water and packed into a sprayer that used by the patient three times daily in each nostril for 45 days. Post treatment evaluation included symptom score improvement, clinical examination and post treatment histopathology. Results showed a significant reduction in patient's symptoms especially foul nasal discharge and crust formation. Post treatment histopathology results are also presented