utility of sonography for blunt abdominal trauma patients

An optimal screening procedure for blunt abdominal trauma should be fast, accurate, portable, and easy to perform. Many believe that ultrasonography [US] meets these requirements. To evaluate the use of abdominal US for detection of organ injury in patients with blunt abdominal trauma, and/or surgical follow-up as the standard of diagnosis. This prospective study was conducted from Jan 2007 to December 2007, at Alwahda Hospital, Derna-Libya. It included 56 patients [45 males and 11 females] with age ranging from 13 to 87 years; all were admitted for suspicion of blunt abdominal trauma. Patients were assessed clinically and followed within 30 min after admission by an abdominal sonography examination. Rigid abdomen was seen in 29 cases [51.8%], stap wound and pneumothorax in 9 [16.1%], tender abdomen in 8 [14.3%], polytraumatic in 7 [12.5%], abdominal blood collection in 1 [1.8%], gun shot in 1[1.8%] and blunt trauma in 1 [1.8%]. US showed that hem. perineum was seen in 26 cases [46.4%], multiple tear in 16 [28.6%], small tear in 10 [17.9%], laceration in 2 [3.6%], rupture spleen in 1 [1.8%] and not shown in 1 [1.8%]. As regard the outcome, 35 [62.5%] were discharged, 13 [23.2%] were complicated, and 8 [14.3%] were died. US is becoming the screening modality of choice in blunt abdominal trauma. US can help determine the need for surgical intervention within minutes of a patient's arrival. The rapidity, noninvasiveness, and portability of US are responsible for its increasing popularity

study of colonoscopy procedure in Alwahda Derna Hospital from 2004 to 2006

Colonoscopy is currently the best diagnostic modality for evaluating colonic diseases but studies of its use in the very elderly are limited. To review the laparoscopic care at Alwahda Hospital, Derna Libya for the year 2004, to 2006. Retrospective analysis of 75 patients who underwent laparoscopy for recurrent small bowel obstruction from June 2004 to May 2006 was carried out. This study included 75 patients with age ranging from 19 to 84 years. They were 43 males representing 57.3% of cases and 32 were females, representing 42.7% of cases. The main complaint is bleeding representing 30.7% [23] of cases, constipation was found in 20 patients representing 25.7% of studied cases and abdominal pain in 15 cases [20%]. The commonest finding is colitis in 19 patients [25.3%], mass in 8 [10.7%], piles in 6 [8%]. Piles are the predominant complaint of bleeding. Males are more presented for colonoscopy than females except cases of abdominal pain. Adenocarcinoma represented 13.3% of the findindings of histopathological examinations, non-specific colitis represented 9.3%, piles represented 8%, ulcerative colitis and diverticulum represented 6.7% for each, Crohns disease represented 5.3%, hyperplastic, adenomatous polyps and IBD represented 2.7% for each. Laparoscopic diagnosis and treatment of recurrent small bowel obstruction is feasible, safe, and can be performed electively in selected cases. Laparoscopy in diagnosis and treatment of massive small intestinal bleeding is noninvasive with less pain, short recovery time and definite therapeutic efficacy

Role of tumor marker CA15-3 in breast cancer patients before and after mastectomy

CA 15-3 is the most widely used serum marker in breast cancer. Currently, its main uses are in the surveillance of patients with diagnosed disease and monitoring the treatment of patients with advanced disease. To analyze the relationship between serum levels of CA15-3 and some variables [age, clinical stage, and the number of lymph nodes involved in breast cancer patients]. One hundred and ten females including 55 normal controls, and 55 patients with histologically confirmed breast cancer from inpatients and outpatients clinics at Alwahda outpatients clinics, Derna - Libya, from 1/7/2007 to 31/12/2008, entered this study. Preoperative CA 15-3 concentrations were measured prospectively. A second and third sample was obtained from patients who were diagnosed as having breast cancer, one week and one month post mastectomy, respectively. Marker levels were related to patient outcome and statistically analyzed.CA15-3 was measured by ELISA. Patients with breast cancer had significantly elevated CA15-3 levels than that in the normal controls [P<0.05]. One week after mastectomy, the mean +/- SD serum CA15-3 was 18.3 +/- 14.6 U/mL. However, a month later, the mean +/- SD was 21.7 +/- 19.7 U/mL, which was approximately the same as the preoperative values [mean +/- SD: 22.1 +/- 25.6 U/mL]. The correlation between the elevated CA15-3 values and the number of involved lymph nodes was significant [P < 0.001]. Patients with high preoperative concentrations of CA 15-3 [>30 units/L] had a significantly shorter overall survival pattern than those with low concentrations. CA 15-3 was independent of tumor size, axillary node status, and patient age. CA 15-3 predicted outcome of patients, including those with node-negative and node-positive disease. CA 15-3 was also predictive of outcome irrespective of the type of adjuvant therapy administered, i.e., whether adjuvant hormone therapy, adjuvant chemotherapy, or radiotherapy was administered. Measurement of CA 15-3 is a relatively inexpensive, convenient, and noninvasive method for evaluating prognosis in newly diagnosed breast cancer patients

Pattern of thyroid diseases and their impact on health related quality of life

The importance of patient-reported outcomes such as health-related quality of life [HRQL] in clinical research is increasingly acknowledged. In order to yield valid results, the measurement properties of HRQL questionnaires must be thoroughly investigated. Objectives: To study the pattern of thyroid disorders [hyperthyroidism and recurrent goitre] in surgical department at Al-Wahda Hospital, Derna, Libya, 2004-2006 and their impact on HRQL. Two hundred and ninety six [296] patients admitted to surgery department at Al-Wahda Hospital, Derna, Libya, 2004-2006 were studied. T3,T4 and TSH estimations was done. A hyperthyroidism Complaint Questionnaire was preformed on 57 patients and Chronic Thyroid Questionnaire was preformed on 46 patients. Out of 296 patients with age ranging between 14 and 70 years, 276 [93.2%] were females and 20 [6.8%] were males. Fifty seven [19.3%] of cases showed hyperthyroidism and 46 [15.5%] showed hypothyroidism [recurrent goitre] by laboratory hormonal assays. Lobectomy was done to 146 [49.3%] of cases [65 cases right, 35 cases were left and 46 cases were isthmusectomy]. Near total thyroidectomy was done in 67 [22.6%] cases, subtotal in 53 [17.9%] cases, recurrence in 13 cases and total thyroidectomy in 2 cases. About half of the patients had reduced overall quality of life and general health, limitation in usual activities, as well as social and emotional problems. Two thirds were fatigued and about one third were anxious and had cognitive as well as sexual problems. It appears that persistent HRQL impairment is very frequent among patients with both hyper-and hypothyroidism

diagnostic value of helicobacter pylori tests and endoscopy for peptic ulcer patients

Guidelines for management of peptic ulcer patients after initial treatment are largely directed to detection of H. pylori infection using non-invasive tests. 2600 patients with dyspeptic complaints were referred for gastroscopy. The endoscopic and histological findings were evaluated according to the Sydney classification. Stool Antigen test, and ELISA investigations were performed. Out of 2600 patients, [1300] representing 50% had positive endoscopic findings. From these patients, 533 patients [41%] showed peptic ulcer, 403 were duodenal and 130 were gastric. 357 [67%] were males and 176 [33%] were female, with a male: female ratio 2:1. Out of 533 patient with peptic ulcer by endoscopy, 451 [84.6%] had positive endoscopic for H pylori. The prevalence of H pylori infection was 66% in Stool Antigen test and 62% in ELISA test. The healing rate in anti H pylori treated group was significantly higher than the non treated group [95% and 75%, respectively] [X2 = 15.7, P< 0.001]. The recurrence rate 5 years was significantly lower than the untreated group [31% and 73%, respectively] [X2 = 35.3 P< 0.001]. Patients with dyspepsia should not be monitored only by non-invasive investigation methods [ELISA and stool antigen test as they have shown good concordance]; it is also justified to use the classical histological evaluation of H. pylori colonization, Moreover, endoscopy and histological investigation of a gastric biopsy have proved to be methods with additional diagnostic value, providing the physician with information about inflammatory, atrophic and metaplastic lesions of the stomach in dyspeptic H. pylori positive and negative patients

Laparoscopic and open cholecystectomy in Alwahda Hospital during 2007, Derna-Libya

Cholecystectomy is one of the most frequently performed operations. Various series have demonstrated that the laparoscopic approach leads to a reduction in postoperative pain and diminished postoperative hospitalization and disability. To evaluate laparoscopic Cholecystectomy [LC] in relation to open Cholecystectomy [OC] in the surgical treatment conducted in Al Wahda Hospital, Derna. Libya, during 2007. Sixty patients undergoing elective Cholecystectomy for symptomatic gallstones were studied. The patients were allocated in the two groups of 30 each by simple random technique. Group-1 underwent OC and Group-11 underwent LC. The patients were then followed up to pick up signs of wound infection. In case of infection, the degree of infection was documented and the results analyzed. The age of patients ranged from 21-80 years with the maximum number in the 4th decade [30] patients. The commonest presentation was chronic cholecystitis in both groups, 15 patients [50%] in laparoscopic and 12 [40%] patients in OC group. There was no wound infection in any case of chronic cholecystitis [zero] out of 27 cases, ail 4 instances of wound infection in occurred in acute cholecystitis / empyema. [4 / 33] representing 6.6%. In case of LC group there was only one of Class-ll wound infection in a patient suffering from empyema. In case of OC there were 3 cases of wound infection. Out of these, one was of class-ll and two of Class -III. Both Class- II infections. The frequency of wound infection was three times as common in OC as compared to LC

clinical trial comparing laparoscopic and open appendectomy

Numerous single-institutional randomized clinical trials have assessed the efficacy of laparoscopic and open appendectomy. The results, however, are conflicting. To compare length of hospital stay, duration of the operation, in-hospital complications, and rate of routine discharge between laparoscopic and open appendectomy. Patients with primary ICD-9 procedure codes for laparoscopic and open appendectomy were selected from the inpatient sample, 120 representing 20% of all Alwahda hospital discharges, Derna, Libya, during the year 2006. In addition, 30 inpatient underwent laparoscopic appendectomy at St. Marian hospital, Mulhein an der Ruhr, Germany. Thirty [30] patients [20%] underwent laparoscopic and 120 patients [80%] open appendectomy. Patients had an average age of 26.7 years. Laparoscopic appendectomy was associated with shorter median hospital stay [laparoscopic appendectomy: 2.3 +/- 0.9 days, open appendectomy: 3.7 +/- 1.2 days, P < 0.001], lower rate of infections [odds ratio [OR] = 0.4 [0.38, 0.66], P < 0.001], decreased gastrointestinal complications [OR = 0.8 [0.68, 0.96], P = 0.02], lower overall complications [OR = 0.84 [0.75, 0.94], P = 0.01], and higher rate of routine discharge [OR = 2.8 [2.5, 4.5], P < 0.001]. Laparoscopic appendectomy has significant advantages over open appendectomy with respect to length of hospital stay, rate of routine discharge, and postoperative in-hospital morbidity

Evaluation of a treatment protocol for mastalgia with topical NSAIDs at Alwahda Hospital, Derna, Libya

Breast pain is the most common breast symptom causing women to consult primary care physicians and surgeons. Mastalgia is more common in premenopausal women than in postmenopausal women, and it is rarely a presenting symptom of breast cancer. Many medical treatments have been used to relieve mastalgia, but some medications produce undesirable side effects. The aim is to evaluate the use of topical NSAIDs in the treatment of mastalgia. From January 2006 to December 2006 a total of 176 women underwent breast examination at Alwahda Hospital, Derna, Libya. Subjects were aged between 19 and 54 years old. The experimental protocol included a prospective study of a group of 109 patients suffering from mastalgia with a 3-month follow-up. Patients witli mastalgia who had normal results on routine biochemistry and hormonal testing and negative evaluations for breast cancer were enrolled in the study. Of those admitted to the study, only 100 completed the course. Patients were assigned randomly to use of a topical NSAID preparation [Voltaren gel] every eight hours [50 women] or a topical placebo cream applied to the breast skin [50 women]. All of the patients were advised to decrease their intake of caffeine. Pain was measured using a visual analog scale during the three months of treatment. After three months, the pain score was markedly improved among participants receiving the topical NSAID treatment. Almost 50 percent of the treated participants reported no pain at the end of the study. No side effects occurred among any of the participants. Applying topical NSAIDs over a three-month period can relieve the pain of mastalgia with minimal adverse effects