Is there an association between type 1 diabetes in children and Gallbladder stones formation?

A number of studies in adults have evaluated the prevalence of gallstones in the diabetic population and showed a significant association with type 1 diabetes [T1D] and type 2 diabetes. The pediatric literature is limited to a single small case series. We conducted a cross-sectional study to evaluate for the presence of association between T1D in children and gallstones formation. Children diagnosed with T1D in a diabetic clinic have been examined for existence of gall bladder stone formation from November 2008 through November 2009. All have been subjected to the following: History, physical examination, blood tests [liver function tests, lipid profile, glycosylated hemoglobin [HbA1C]], and an ultrasound [US] of the gall bladder. One hundred and five children with T1D have been enrolled consecutively over a 1-year period: age ranged between 8 months and 15.5 years, 62 patients were females. The mean age at diagnosis was 6.3 +/- 2.9 years [range 0.85-11 years], mean duration of T1D was 2.2 +/- 2.1 years [range 0.2-8 years], mean body mass index was 16.5 +/- 3.4, mean HbA1c was 10.7 + - 2.4%, and 61.3% of patients had a HbA1c level >10%. The mean serum cholesterol was 4.16 +/- 0.75 mmol/L [normal 3.65-5.15 mmol/L] and mean serum triglyceride 1.02 +/- 1.3 mmol/L [normal 0-1.7 mmol/L]. Two patients had hyperlipidemia. US of the gallbladder did not show any case of gallstones or sludge formation. Data from our study do not show any association between T1D in children and gallstones formation, with diabetes duration of less than 8 years. The relatively short duration of diabetes and possibility that our study was underpowered might have been reasons for the absence of any association

Efficacy and side effects of glyceryl trinitrate in management of chronic anal fissure

Various options are available for treatment of chronic anal fissure, each with its own associated complications. This study aimed to evaluate the efficacy of topical Glyceryl Trinitrate [GTN] for anal fissures in an outpatient setting. A prospective experimental study was carried out at the outpatient department of Surgical Unit IV, Liaquat University Hospital from Aug 2004 to Jul 2005. Total 100 patients fulfilling the criteria of chronic anal fissure were included in the study. Patients presenting with chronic anal fissure but with associated comorbidities were excluded. Data were collected on a designed questionnaire, and analysed using SPSS-10. Sixty women and 46 men were included in the study with a mean age of 30 years. After the end of 8 weeks of treatment, 76 showed healing of fissure and relief in symptoms whereas 20 patients either had improvement in symptoms or did not heal. The commonest side-effect was headache reported by 21 patients. The minimum period of follow-up was one year, and 7 patients had recurrence. Topical 0.2% GTN is an effective first-line agent in managing chronic anal fissure. The associated side effects and recurrence remains a matter of concern.

Appendecectomy during pregnancy. a comparison of laparoscopic with open appendicectomy in respect of safety and morbidity to mother and fetus

Acute appendicitis is the most frequent non-obstetric emergency that require surgery for the period of pregnancy. The aim of the study was to assess Laparoscopic versus Open method of appendicectomy in pregnant patients in respect of benefits and hazards to patients and fetus. Comparative Study. This study was conducted at Alrass General Hospital Saudi Arabia from 1[st] March 2008 to 1[st] June 2010. Pregnant women having acute appendicitis admitted in Alrass General Hospital Saudi Arabia and underwent open or laparoscopic appendicectomy were studied. A total of 118 pregnant women were operated for acute appendicitis. 66[55.9%, n = 118] patients underwent open and 52[44.1%, n = 118] patients underwent Laparoscopic appendicectomy. Mean age +/- SD [range] of patients 23.45 +/- 4.5 years [18-38] in OA [open appendicectomy] group and 22.00 +/- 2.94 years [17-37] in LA [Laparoscopic appendicectomy] group. Mean gestational age was 16.51 +/- 4.17 weeks [11-26] in OA and 18.28 +/- 4.61 weeks [10-27] in LA group. There were no fetal loss in any group. Pre-term delivery occurred in 6[9.1%] patients in OA and in 4[3.7%] patients of LA group. In laparoscopic surgery there is no increased risk to mother and fetus as compare to open surgery

comparative study of the results of the anal fissurectomy and lateral internal sphincterotomy for chronic anal fissure

To compare the results of surgical treatment of chronic anal fissure resistant to conservative management, after anal fissurectomy or lateral internal sphincterectomy. One hundred forty five patients with chronic anal fissure failed to heal with medical treatment admitted in the Department of Surgery Unit II Liaquat University Hospital Jamshoro Sindh Pakistan, from January 2007 to June 2009 were studied. Patients were divided into two groups, 67 patients underwent Fissurectomy [F], and 78 patients underwent open lateral internal sphinterotomy [LIS]. We assessed the patients after median follow up of 12 months, for persistence of symptoms [pain, bleeding], complications and recurrence. All patients become symptoms free within 10 days of surgery. Urinary retention was noted in 3[2.06%] patients, 2[2.98%] in fissurectomy [F] and 1[1.28%] in lateral internal sphincterectomy [LIS] group. Incontinence to flatus was noted in 2[2.98%] patients of 'F' group and 1[1.28%] patient of 'LIS' group. Faecal soiling was noted only in 1[1.49%] patient of 'F' group. Recurrence occurred in 3[4.41%] patients of 'F' group, no recurrence seen in 'LIS' group. Wounds healed within six weeks. Sixty two [91.17%] patients of 'F' and 77[98.71] patients of 'LIS' group were satisfied with treatment. In the treatment of chronic anal fissure lateral internal sphincterectomy is the best surgical technique with very few complications and better patient satisfaction

Hereditary 125-dihydroxy vitamin D-resistant rickets-a report of several cases in a Kindred

We report a Bahraini family with five cases of vitamin D resistant rickets and alopecia. Investigations confirmed the diagnosis of hereditary vitamin D resistant rickets, type II in 2 of the siblings who were fully investigated. Although we do not have data to support it, we believe all the sibs had the same type of rickets

Hirschsprung's disease in Bahrain

Ten cases of Hirschsprungs disease presented from Salmaniya Medical Centre. The clinical presentation, the radiological appearance and the pathological findings were described. The surgical treatment and its results were discussed