ABSTRACT
Gastroesophageal reflux disease [GERD] is a very common disease. GERD is defined as the reflux of stomach content which causes troublesome symptoms and/or complications. The management of GERD is step by step. Dietary and lifestyle modifications are the first steps. Twice-daily H2RAs at standard doses for a minimum duration of two weeks can be considered in patients with GERD who fail to respond to lifestyle and dietary modifications. If symptoms of GERD persist, once-daily Proton Pump Inhibitors [PPIs] can be recommended. Patients with an unsatisfactory response to once-daily PPIs dosing can be considered to have refractory GERD. Twice-daily PPI therapy can be recommended in patients who fail to respond to once-daily PPI therapy. The add-on treatment with H2RAs, baclofen, or visceral pain modulators can be considered in selective subjects with GERD who fail to respond to twice daily PPI. Anti-reflux surgery may be taken into account in selected patients. This review focuses on the initial and maintenance therapy of GERD and also reviews different management of recurrent and refractory GERD
ABSTRACT
Objectives: To evaluate the short-term outcome of open appendectomy, the rate of negative appendectomy as well as pathology reports after surgery in patients with suspected acute appendicitis
Methods: This was a retrospective cross-sectional study being performed in Nemazee hospital affiliated with Shiraz University of Medical Science during a 2-year period between 2008 and 2010. The medical records of all consecutive patients who underwent open appendectomy in our center due to acute appendicitis were included in the study. The elective and laparoscopic appendectomies were excluded. The demographic information, clinical findings, laboratory investigations and the histopathological examination of the appendix were recorded and reported
Results: A total of 337 patient including 137[36.4%] females, and 240[63.6%] males with the mean ageof 16.26 +/- 9.81 [range 3 to 76] years were stduied. Anorexia [64.7%]and fever [20.7%] were more prevalent symptoms. The mean duration between pain initiation and operation ranged from 0 to 14 days with mean 1.88 +/- 1.63 days. Right lower quadrant [RLQ], periumbilical, epigastria, left lower quadrant [LLQ], and Right upper quadrant [RUQ], pain were manifest in 78.8%, 41.6%, 12.2%, 3.2%, and 1.3% of patients, respectively Pathological evaluation of the appendix showed appendicitis in 70.4% of patients
Conclusion: The higher rate of negative appendectomy accounts for wasteful tapping of medical resources and causing further complication in patients. Therefore it is essential to conduct more accurate studies to detect the root cause of the disease. This would help improve the management of appendicitis which is an emergency condition with high incidence
ABSTRACT
Guidelines on implant removal are not clear and the routine removal of orthopaedic fixation devices after fracture healing remains an issue of debate. Few studies have evaluated long-term outcomes of patients with orthopaedic implants left in-situ and this lake of data has made the orthopaedic surgeons decide on implant removal differently. In order to add new data in this field, we designed this study. In a follow up setting, patients with Tibial shaft fractures who had received orthopaedic implants in year 2008 and earlier were clinically examined for any surgical complications such as pain or limited range of motion. Quality of life of each patient was evaluated using short form 36. The total SF-36 score of the patients was not statistically different from the normal population [P >0.05]. 21 patients [31.2%] reported limited range of motion in ankle and 11 [14.9%] complained of weakness in the affected limb. Clinically, 68.9% of patients had full range of motion in ankle and 70.3% had no tenderness in the affected limb. As most patients were clinically normal and had quality of life scores comparable to the normal population, removal of implants is not advisable in all patients