pattern of dysphagia in children

Difficulty in swallowing is not uncommon among children and yet little information is available in the literature. We report our experience on the pattern of this condition. We extracted data from the medical records of 42 children with dysphagia on age at presentation, nationality, gender, and final diagnosis. From 1993 to 2002, 96% of 42 children presenting with dysphagia were Saudi nationals, ranging in age from 3 months to 18 years, with a male to female ratio of 1:0.6. An etiologic diagnosis was found in 30 children [72%]. Esophagitis, esophageal strictures and motility disorders were the most common causes of dysphagia, occurring in 16 [38%], 7 [17%], and 4 [10%] children, respectively. Two children had esophageal webs and one had an esophageal ring. Age-related analysis indicated that most of the cases of esophagitis [11/16, 69%] and strictures [5/7, 71%] occurred in young children whereas most nondemonstrable causes occurred in older children [9/12, 75%]. This report documents a pattern of dysphagia in Saudi Arab children that is similar to descriptions from other countries

Management of post laparoscopic cholecystectomy major bile duct injury: comparison of MRCP with conventional methods

Postlaparoscopic cholecystectomy bile duct injury remains one of the devastating complications seen in current surgical practice. Aim of study: This study describes the diagnostic role of magnetic resonance cholangiopancreatography [MRCP] in such injuries compared with conventional methods. Patients and Eighteen patients referred to the Division of Hepatobiliary Surgery, King Khalid University Hospital from July 1998 to September 2000 were retrospectively studied. The technique of the repair was by utilizing Roux- en- Y hepaticojejunostomy with establishment of mucosa- to- mucosa anastomosis. The study included presentation, age and gender. The presentation of patients were variable and frequently included pain, Jaundice with or without cholangitis in 13 patients, bile leakage with development of biliary peritonitis in three, and development of external biliary fistula in two patients. Beside lower incidence of complication, MRCP was more diagnostic and informative in planning surgery by mapping both ducts proximal and distal to site of injury or stricture in 14 out of 18 patients. The Bismuth level of bile duct injuries were type I in one, type II in five, type III in 11 and type IV in one patient. All patients are alive, well and no complications occurred in the immediate postoperative period. Only two patients developed stricture within four months after surgery, one of them treated conservatively with repeated dilatation and stenting was done for the other. Hepaticojeunostomy is the procedure of choice for repair of bile duct injuries and provides adequate bilairy drainage. MRCP is an ideal diagnostic test when bile duct injury is suspeted following laparoscopic cholecystectomy

Gammaglutamyl transpeptidase activity in patients with schistosomiasis

Schistosoma mansoni infestation may induce liver fibrosis and portal hypertension, with possible elevation of liver enzymes. Aim of the study: The aim of this study was to evaluate the serum gammaglutamyl transpeptidase [GGT] activity in a group of non- alcoholic and non-obese patients with hepatointestinal schistosomiasis. Patients and methods: Medical records of 174 patients diagnosed to have hepatointestinal schistosomiasis on the basis of clinical and laboratory data patients diagnosed to have hepatointestinal schistosomiasis on the basis of clinical and laboratory data were reviewed. Body mass index [BMI] was calculated for all patients. Direct stool smear and formol-ether concentration [FEC] methods and hematological and biochemical blood tests were performed. Other studies including abdominal ultrasonography, upper and lower gastrointestinal endoscopy was also performed when feasible. All [174] patients were adults with male to female ratio of 3.8:1. BMI was similar in both groups. Patients were divided into two groups: group 1 [57] with elevated GGT and group 2 [117] patients with normal GGT. Both groups had positive indirect hemagglutination test [IHA] for schistosomiasis. Other causes of liver disease were excluded. Group 1 had significant elevation of alanine aminotransferase [ALT], alkaline phosphatase [ALP] and reduction in platelets [P<0.001], low albumin and high globulin levels [P>0.01] compared to group 2. Abnormal ultrasonographic findings were more frequently encountered in group 1 [P<0.001]. The above data indicated that GGT elevation was most likely secondary to hepatobiliary involvement by Schistosoma mansoni and may indicate chronicity. There fore schistoromiasis has to be cousidered in our bcomunity when even GGT is elevated in non-Al coholi population Alcoholic pouplation