Removal of nasogastric tube accidentally stitched to roux-en-Y oesophagojejunostomy following a radical gastrectomy for stomach cancer: case report and review of the literature

Nasogastric tubes [NGTs] are important for feeding, stenting and decompression after gastrointestinal surgeries, particularly in the upper gastrointestinal tract. Resistance in the removal of a NGT is a rare surgical complication and may be due to a knot in the tube or a stitch anchoring the tube to an anastomosis. We report a 41-year-old male patient who was admitted to the King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, in 2015 with stomach cancer. He underwent a radical total gastrectomy with a Roux-en-Y oesophagojejunostomy. One week after the surgery, removal of the NGT was attempted; however, this was very difficult and the proximal end of the tube was cut off as a temporary measure. Six weeks later, an upper gastrointestinal tract endoscopy revealed that the distal end of the NGT had been accidentally stitched to the Roux-en-Y oesophagojejunostomy. The stitch was removed and the rest of the NGT was successfully extracted using a snare

Skin infections in male pupils of primary schools in Al Ahsa

To determine the prevalence, the nature, and the possible socio-demographic risk factors involved in the development of common transmissible skin disorders [TSD] among the studied population. A cross-sectional consecutive survey was carried out from November 15, 2008 to May 14, 2009 in Al-Ahsa governorate. This study included 1337 male primary school children. Data were collected using the following tools: Socio-demographics and hygienic habits according to pre-established forms and a thorough dermatological examination of all the included children. The prevalence of TSD was 27.15% with a statistically significant difference according to rural/urban locations [33.74% vs. 22.27%]. Fungal infections were the leading diseases [9.1%] followed by bacterial infections [8.9%], parasitic infestations [4.3%], and viral infections [4.1%]. TSD were significantly more frequent in students whose fathers have a primary or preparatory educational status and in the students having the habit to play barefooted. Our study found that TSD was relatively frequent among male primary school students in Al-Ahsa. Our study has several limitations. One major limitation is that female primary school students were excluded from the study. Despite this major limitation, we hope the findings may be useful in planning health care programs for Saudi children with the hope of reducing the prevalence of TSD in the future

Assessment methods of an undergraduate psychiatry course at a Saudi University

In Arab countries there are few studies on assessment methods in the field of psychiatry. The objective of this study was to assess the outcome of different forms of psychiatric course assessment among fifth year medical students at King Faisal University, Saudi Arabia. We examined the performance of 110 fifth-year medical students through objective structured clinical examinations [OSCE], traditional oral clinical examinations [TOCE], portfolios, multiple choice questions [MCQ], and a written examination. The score ranges in TOCE, OSCE, portfolio, and MCQ were 32-50, 7-15, 5-10 and 22-45, respectively. In regression analysis, there was a significant correlation between OSCE and all forms of psychiatry examinations, except for the MCQ marks. OSCE accounted for 65.1% of the variance in total clinical marks and 31.5% of the final marks [P = 0.001], while TOCE alone accounted for 74.5% of the variance in the clinical scores. This study demonstrates a consistency among the students' assessment methods used in the psychiatry course, particularly the clinical component, in an integrated manner. This information would be useful for future developments in undergraduate teaching

Whole body [18]F-FDG PET predicts progression free and overall survival in squamous cell carcinoma of the esophagus: results of a prospective trial

[18]F-FDG PET yields physiologic information that allows for identifying cancer based on altered tissue metabolism. The aim of this study was to prospectively validate the predictive value of positron emission tomography [PET] in squamous cell carcinoma [SCC] of the esophagus treated by pre-operative chemotherapy followed by esophagectomy. Prospective efficacy and toxicity study of patients enrolled between January 1999 and September 2003. Twenty-one patients with SCC of the esophagus who were potentially resectable underwent [18]F-FDG PET imaging before the first cycle of neoadjuvant chemotherapy and at least 14 days after the third cycle. A patient was classified as a metabolic responder when the metabolic activity of the primary tumor as measured by the maximum standardized uptake values had decreased by 50% or more at the time of the second [18]F-FDG PET. The median age of the study cohort was 60 years with a range of 39-70 years; 12 patients were males and 9 were females.[18]F-FDG PET had increased activity in the primary tumor in all patients. Metabolic response occurred in 14/21 patients [66%], while 7/21 [33%] patients did not show a metabolic response. Metabolic responders had a high clinical response rate [92%], a median progression free survival [PFS] of 16.4 months and a median overall survival [OS] of 35.3 months. In contrast, prognosis was poor for metabolic non-responders with a clinical response rate of 42% [P=.025], a median PFS of 7.13 months [P=.032] and median OS of 12 months [P=.038]. Our results demonstrate that changes in tumor metabolic activity after neoadjuvant chemotherapy predicts PFS and OS in esophageal SCC patients

Epidemiologic approach for early detection and control of renal and urinary tract diseases in rural populations

The dipstick testing, microscopic examination of urine and urine cytology were performed for inhabitants from two rural villages [El Shobak El Sharki, V.I and El Katta, V.2] in Giza G. The proliferating cell nuclear antigen [PCNA] and Schistosoma haematobium antigen were done by immuno-histochemical stain to confirm diagnosis. Also, they were subjected to medical questionnaire, clinical examination, ultra-sonography of kidneys and urinary tract. The results showed that V.2 had higher percentage of haematuria, proteinuria, glucosuria and lower urinary tract infection than V.I. Crystaluria was higher in V.I. Sensitivity of dipstick testing compared to microscopic examination was 26.6%, and specificity was 78.7%. Lower urinary tract infection cytologically detected was 44.2% sensitivity and 62.5% specificity compared to pyuria detected by microscopic examination of urine. Among those suffering variable urinary abnormalities, schistosome antigen was not detected in any fixed urine samples in comparison to corresponding confirmed positive controls. Urine cytology detected urinary tract infection, Crystaluria, dysplasia and atypia, squamous metaplasia and transitional cell carcinoma [TCC]. PCNA positivity was found in TCC [100%], dysplasia [50%] and squamous metaplasia [28.6%]. So, microscopic examination of urine proved valuable for tract abnormalities as pyuria, haematuria and crystaluria. Also, urine cytology is a must for malignancy of urinary tract especially in adult males

Biological markers in Helicobacter pylori-associated gastritis and carcinoma : the value of a scoring system

Background: Helicobacter pylori-associated gastritis has been linked to the pathogenesis of gastric adenocarcinoma [GA], especially when associated with intestinal metaplasia [IM] and atypia/dysplasia [A/D]. We examined p53 expression, ploidy and proliferative activity and assessed H. pylori infection in relationship to IM and/or A/D in cases of gastritis not associated with GA and in cases of GA

Methods: We examined 53 gastric biopsies from patients with gastritis not associated with GA, including patients with gastritis not associated with IM and/or A/D [n=35] and with gastritis associated with IM and/or A/D [n=21]. Thirty-six distal gastrectomy specimens from patients with GA constituted a third group of patients. A scoring system that encompassed the presence or absence of H. pylori, degree of gastritis, IM and/or A/D, p53, MIB-1 proliferative index [MPI] and ploidy was estimated in the cases of gastritis and in cancer-associated mucosa [CAM] and the adenocarcinoma from patients with GA

Results: Patients with GA had a higher median age than those with gastritis without IM and more were males [ratio, 2.2:1]. H. pylori was detected in 75% [40/53] of gastritis specimens and in 55% [20/36] of GA cases. There was a statistically significant difference between the incidence of gastritis without IM and/or A/D and CAM [P=0.01]. p53 expression was seen in 67% of cases [14/21] of gastritis with IM and/or A/D and in only 5% [2 cases] of gastritis without IM [P=0.0005]. A statistically significant difference in MPI was seen between CAM and GA [P=0.01] and gastritis without IM and/or A/D and gastritis with IM [P=0.004]. Cases of gastritis without IM and/or A/D had a median score of 8 while cases of gastritis with IM and/or A/D had a median score of 12 [P=0.0003]. CAM had a median score of 13, which was significantly different than gastritis without IM and/or A/D [P=0.0003]

Conclusion: The presence of IM and/or A/D can be used in H. pylori-associated gastritis as a starting point to further investigate high-risk lesions. Those showing p53 expression, high proliferative activity and aneuploidy require closer follow up and perhaps additional biopsies. Although aneuploidy is commonly seen in GA, its presence in cases of gastritis as an isolated finding should not indicate a high-risk lesion

Serum thrombopoietin levels in patients with liver cirrhosis; relation to severity of the disease, spleen size and platelet count

Background: thrombopoietin [TPO] is an important regulator of megakaryocyte maturation and platelet production. The role of TPO [which is mainly produced by the liver] in thrombocytopenic cirrhotic patients is still under investigation. The aim of this study was to measure the serum TPO levels in cirrhotic patients and examine its relationship with circulating platelet count, splenic size and clinical stage of liver cirrhosis

Study design and methods: this study was conducted on 88 subjects, divided into 2 groups, group I [patient group] included 72 patients with liver cirhosis [diagnosed by combination of clinical, laboratory, ultrasound and histopathological data], they were further divided into 2 subgroups, group IA: included cirrhotic patients with thrombocytopenia [36 patients, 28 males and 8 females with age 50.3:8.5 years], and group IB: included cirrhotic patients with normal platelet count [36 patients, 26 males and 10 females, with age 50.64+/-6.8 years]. Group ll comprised 16 healthy persons with matched age and sex, used as a control group. All included persons were subjected to: thorough history taking, full clinical examination, beside the following investigations: complete blood picture, kidney and liver function tests, Hepatitis B and C markers, serum TPO level [by sensitive sandwich ELISA] and abdominal Doppler ultrasound. The following invasive investigations were done for group I [patients] only: bone marrow aspiration, upper gastrointestinal endoscopy, sigmoidoscopy and liver biopsy [the latter was done for 21 patients only]. Patients with pure schistosomal fibrosis were excluded from the study. Patients were classified according to the Child-Pugh score into 3 classes of clinical severity A, B and C

Results: cirrhotic patients were thrombocytopenic in comparison to control [P<0.0001]. Serum TPO levels were lower in cirrhotic patients [130.6-79 Pg/mi] than control group [225.5-36 pg/m] [P<0.0001] and also in patients with thrombocytopenia [101-77.5 pg/m] than in patients with normal platelet count [160.2-70.3 pg/m] [P<0.001]. TPO had a significant positive correlation with platelet count [P-0.0001 for sub-group IA and P=0.04 for subgroup 1B]. However serum TPO did not correlate with spleen size. Splenic size had a significant negative correlation with platelet count in cirrhotic patients [P-0.03 for subgroup IA and P=0.004 for subgroup 1B]. In cirrhotic patients, serum TPO levels were found to be decreased as the disease progressed in subgroup IA, 188.25+73.05 pg/ml in patients of Child-Pugh class A, 63.8:23.28 pg/ml in class B and 51:26 pg/ml in class C, while in group 1B, 247.3:40.49 pg/ml in class A 121.3+/-29.6 pg/ml in class B and 112+/-27 pg/ml in class C]. Child-Pugh score has a significant negative correlation with TPO level in both sub-groups IA and 1B [P=0.0001] and with platelet count [P=0.0001 for subgroup IA and 0.01 for subgroup IB], but no significant correlation with spleen size. In comparing class A, B and C in both subgroups [IA and IB], spleen size was significantly larger in Child class A of subgroup IA when compared to same class of subgroup 1B [P-0.0001] with slight significant decrease in TPO in class A of subgroup I than class A of subgroup B [p-0.02]

Conclusion: we concluded that low TPO production may play a role, along with hypersplenism, in the development of thrombocytopenia in patients with liver cirrhosis. In early stage of cirrhosis [Child-Pugh class A], splenomegaly and hypersplenism may be the main path mechanism of thrombocytopenia. While advanced liver cirrhosis [Child-Pugh class B and C], causing more reduction in TPO production, plays a central role in the pathogenesis of thrombocytopenia