management of colorectal cancer patients in Al-Gamhouria Teaching Hospital from June 2004 to December 2006

Colorectal cancer [CRC] is the third most important cause of cancer mortality overall, with similar number of deaths in both sexes. If it is detected early, it will be curable by surgery. Our aim is to assess the management of CRC in patients admitted to Algamhouria Teaching Hospital in Aden. Patients admitted with CRC, during the period June 12004 to December 31[st] 2006, were prospectively studied. Study variables included sex, age. type of admission, residency, special habits, socio-economic level of the patients, site of the tumor, clinical picture, type of surgical treatment and postoperative complication, as well as macro-and microscopic examination of the specimens. The total number of enrolled patients were 50, 54% of them [27] men and 46% [23] women. Overall mean age was 51.2 +/- 11.4 years [range 17-80 years] and higher frequency of CRC was in patients in the sixth decade [46%]. Elective admission was reported in 66% of them, and emergency in 34%. Most of the patients [98%] presented general weakness and signs of anemia. The frequent site of the tumor was rectum [42%], followed by left colon and sigmoid [34%]. Abdomino-perineal resection was performed in 36%, followed by left hemicolectomy in 32%. The most frequent post-operative complication was infection-in 12.24%. The most frequent macroscopic type of the tumor was fungating in 66%, whereas the microscopic pattern identified was adenocarcinoma in 94%. Lymph nodes were involved in 46% of cages, and liver metastases found in 8%. In our patients, CRC had been diagnosed very late. There should be high suspicious index for CRC in patients with bowel complains, especially in their 5[th] and 6[th] decades of their life

Diabetic foot: clinical presentation and management in Al-Gamhuoria Teaching Hospital

The aim of this study is to determine the mode of presentation, medical and surgical treatment. and prevention of diabetic foot. This is a prospective descriptive study performed in the period from June 2004-December 2005. Eighty-three patients with diabetic foot lesion were presented to Al-Gamhorea Teaching Hospital. Data of these patient were collected for sex, age, duration of diabetes, blood sugar control, mode of presentation, presence of peripheral neuropathy, peripheral vascular disease, concurrent medical illness [ischemic heart disease and chronic renal failure], microbial flora, treatment by antibiotics, surgical treatment and duration of healing. Majority of patients were male above 50 years 68.7%, mean age 58.3 +/- 12 and female 3 1.3%. Most of them were type 2 on oral hypoglycemic drugs [89.16%]. Blood sugar was uncontrolled in 77.1% of them. History of trauma preceding diabetic foot infection was present in 74.7%. Foot ulcer was the most common presentation in 47% of patients. There was a significant association between the peripheral neuropathy and the following risk factors: duration of diabetes more than ten years 100% [p = 0.0000], poor glycemic control 95.3% p.000] and trauma 83.9% [p = 0.0000]. There was also a significant relationship between the major limb amputation and some predictive variables: previous foot ulcer 35.3% [p=0.0000]. poor glycemic control 17.2% [p = 0.04], peripheral neuropathy 17.7% [p = 0.03], peripheral vascular disease 75% [p = 0.000], and heart disease 33.3% [p = 0.01]. Debridement done for 9.4% and toe/s amputation for 30.2%, however 11 patients [13,3%] had major amputation. Staphylococcus aureus was the most common organism isolated in 34.9%. Duration of healing was 9-16 weeks for most of the patients 63.4%. Diabetic foot infection is a common health problem in Al-Gamhorea Teaching Hospital, particularly among men. Poor glycemic control, as well as peripheral neuropathy and peripheral vascular disease are the most precipitating factors. which can be prevented. Control of blood sugar, good debridement, and proper dressing can lead to early and complete healing in most of diabetic foot lesions

Management of perforated peptic ulcer in Al-Gamhouria teaching hospital, Aden

We aimed to explore and analyze the current status in management of patients with perforated peptic ulcers. The study was carried out at the surgical department of Al-Gamhouria Teaching Hospital, Aden-Yemen. Patients, admitted with perforated benign peptic ulcers, during the period January 1997 to December 2006, were retrospectively evaluated. The total number of enrolled patients was 156; 138 [88.46%] men and 18 [11.54%] women. Overall mean age was 39.08 years [range 14-75 years] and the higher frequency of PPU was in patients of age group 21-40 years [58.34%]. The PDU/PGU ratio was [4.38:1]. The mean time of presentation was 16.5 hours and of the operative intervention after admission was 525 hours. Simple perforation closure was used in [91.67%] of the patients. Postoperative complications rate was 41.03% [statistically significant in cases admitted later than 12 hours], wound sepsis making the majority-55.24%; died 6 patients [3.85%]-correlation with presentation time was not significant. The overall mean post-operative hospitalization period was 12.76 days; 14.74% of the patients stayed more than 3 weeks. Emphasis should be placed on shortening the time to surgery. Simple closure remains the selected treatment in the majority of patients. Improving the surgical skills, wound care, administrative regulations, hospital environment and equipments is needed to reduce the high rate of complications

Current status of management of benign bleeding peptic ulcer in Al-Gamhouria Teaching Hospital, Aden, Yemen

We aimed to explore and analyze current status of bleeding peptic ulcers in surgical patients. The study was carried out at the Surgical Department of Al-Gamhouria Teaching Hospital, Aden-Yemen. It was divided into 2 parts. Group [A] patients, admitted with bleeding peptic ulcers during the period May 1998 to April 2003, were retrospectively evaluated, and the prospective group [B] that included patients admitted during the period May 2003 to April 2006. One hundred and twenty patients were enrolled in the study; 75% were in group [A] and 25% in [B]. Men were [103] and women [17], with a ratio of [6.1:1]. Overall mean age was 43.4 years [ranging 17 to 70 years] with 23 patients [19.17%] over 60 years. Endoscopic activity within the first 24 hours in group [A] was [55.56%] and zero in [B]. Ratio of bleeding duodenal to gastric ulcers was [2:1]. Bleeding was massive and /or recurred in [32.5%] of patients, with transfusion of 3-9 units of blood [mean - 5.38]. Surgery was performed only in the retrospective group - in [11.11%]. Hospital stay time was for group [A] and [B] 17.5 and 9 days respectively. Overall death rate was [8.33%]; it was less in group [A] than [B] - [6.67%] and [13.3%] respectively. In patients treated only conservatively, death rates in [A] and [B] were [7.5%] and [13.3%] respectively. Nevertheless, death rates were statistically not significant. Overall outlook was quite alarming. Lack of good administration, limited resources, and lack of necessary equipments played the major role in improper management of these patients. To improve the situation, it is recommended to prepare guidelines and establish a well equipped and well functioning endoscopy unit

significance of ultrasound in diagnosing gallstone disease

The efficacy and sensitivity of transabdominal ultrasonography [TUS] for detecting gallstones in patients with biliary colic and biliary tract diseases was studied. A prospective study was carried out between February 2003 and February 2007, in the Surgical Department of Al-Gamhouria Teaching Hospital. Patients with Ultrasound diagnosis of gallbladder [GB] and common bile duct [CBD] stones diseases [including 2 cases with biliary colic like pain and negative TUS result] were admitted to the hospital for cholecystectomy and, in indicated cases for choledochotomy. Presence or absence of stones were noted. CT-scanning was ordered in patients with obstructive jaundice. The computer program Quickcalcs of Graphpad software was applied for data processing [http:/graphpad.com/quickcalcs]. TUS was performed on 114 consecutive patients; 103 [90.35%] were women and 11 [9.65%] were men. The ages ranged between 20 to 80 years, with mean age of 43.62 years. For gallbladder stones; there were 108 True Positive, 2 True Negative, 3 False Positive and one False Negative scans, yielding 94.74% sensitivity, 66.67% specificity, and 96.49% accuracy. Positive Predictive Value [PPV] for gallbladder stones was 16.66% and Negative Predictive Value [NPV] was 97.22%. Nine patients out of 114 [7.9%] had associated with common bile duct obstruction, 6 women [5.26%] and 3 men [2.63%], with 7 True Positive, one False Positive, and one False Negative results for choledocholithiasis, yielding 77.78% sensitivity, 92.11% specificity, and 98.25% accuracy. PPV was 45.78%, whereas NPV was 97.98%. The Ultrasound provided an effective and reliable means for the diagnosis of GB and CBD stone diseases

Breast feeding as a protective factor for breast cancer in the tropics

To study the protective effect of breastfeeding on breast cancer in patients admitted at Al-Gamhouria Teaching Hospital during the period from January 1[st], 2003 to December 31[st], 2004. This was a prospective case control study. The total population was composed of 55patients who were diagnosed with breast cancer and no controls were free from the disease. The controls were matched to the patients on sex and age group criteria and analyzed using statistical test and 95% interval confidence. The difference between patients and controls regarding to never breastfeeding is insignificant with odds ratio 0.88. The difference between patients and controls who had breastfed their children during the period less than 24 months was insignificant with the odds ratio 0.96 with 95% CI: 0.37- 2.64. Among patients who had breastfed their children there is reduction in the risk of breast cancer compared with those never breastfed, OR: 0.88. There is protection from breast cancer among females who breastfed their children within the period >/= 24 months compared with those never breastfed, OR: 0.74. Porous women who breastfed their children for less than 24 months had a borderline reduced risk of breast cancer, OR: 0.96. Breastfeeding for >/= 24 months protect the occurrence of breast cancer more than breastfeeding in less than 24 months compared with never breastfeeding. We recommend to organize regular lectures in mother and child health care centers to emphasize the importance of breast feeding as protective factor for breast cancer and to introduce breast risk factors as part of teaching in mother and child health care centers