Bilateral Proximal Femur Fractures in a Patient with Renal Tubular Acidosis: A Case Report

@#The diagnosis of pathological fractures is on the rise. Themorbidity involved does not only burden the patient and theirfamilies but it has a great toll on the healthcare system aswell. Early identification of the patient at risk is aninvaluable tool to cut cost and improve the patient’s qualityof life. Multiple renal pathologies have been highlighted inrelation to the risk of pathological fractures; however,complications in renal tubular acidosis have been rarelydocumented. Nevertheless, prompt action with adequate andrelevant patient education ultimately can reduce theassociated morbidity. We present a case of poor control ofthe disease and its debilitating pathological fracturecomplications.

Group B streptococcus infection in a sudden unexpected death of infancy – the importance of microbiological investigation at post-mortem

@#Group B streptococcus (GBS) is a common cause of infection in newborns and in early infants. However, GBS infection in an infant older than three months is infrequently reported in the literature. We reported a case of an apparently well six-month-old infant who died of sudden death due to GBS pneumonia, diagnosed at autopsy. The six-month-old, apparently well male infant was brought in dead to the Emergency Department. He underwent medicolegal autopsy four hours after death, as part of an overall sudden unexpected death in infancy investigation (SUDI). Apart from whitish froth oozing out of both nostrils, he appeared to be well-nourished infant without any deformity, syndromic features or obvious suspicious marks of injury externally. Internal examination showed generalized hyperinflated with patchy consolidation of upper and middle lobes of bilateral lung. Multiple matted mesenteric lymphadenopathy were also detected. Blood and lung tissue specimens collected under aseptic technique yielded growth of GBS. Post-mortem histology from consolidated lungs confirmed pneumonic features while mesenteric lymph nodes showed reactive changes inkeeping with underlying infective process. Death was attributed to GBS pneumonia. This case highlights the importance of a detailed autopsy in sudden unexpected death in infancy (SUDI) and the crucial role of post-mortem microbiological study in such cases. Relevant autopsy protocols that need to be employed during microbiological sampling are briefly discussed.

Procoagulant versus anticoagulant factors in cirrhotic patients

Liver cirrhosis leads to decreased production of clotting factors that are generally all produced in the liver except factor VIII and von Willebrand factor. However, cirrhotic patients are not protected from thrombosis. The present study aimed to assess the procoagulant and anticoagulant factors in cirrhotic patients with and without bleeding and/or thrombotic events. A total of 102 adult subjects were enroled: 51 cirrhotic patients and 51 healthy controls. After full history taking with special attention given to thromboembolic and haemorrhagic events, platelet count, serum albumin, bilirubin, international normalised ratio [INR], PT, partial thromboplastin time [PTT], hepatitis B surface antigen [HBsAg], hepatitis B core [HBc] antibodies, hepatitis C virus [HCV] antibodies, factor VIII, protein C, Protac-induced coagulation inhibition percentage [PICI%] assay and abdominal ultrasound were performed for patients and controls. Upper gastrointestinal endoscopy was conducted for the patients. Compared with control subjects, factor VIII and factor VIII/protein C were significantly higher, while protein C and PICI% were significantly lower among patients. Patients with liver cirrhosis may have a tendency for bleeding or thrombosis according to the balance of coagulant and anticoagulant status. PICI%, the assay that evaluated the functionality of the protein C anticoagulant system, was significantly lower in patients compared to control subjects. Accordingly, low PICI% and high factor VIII/protein C ratio can be taken as an index of hypercoagulability in cirrhotic patients

Knowledge and attitude of healthcare professionals toward medication pregnancy category systems in Saudi hospitals

To assess the knowledge and attitudes of healthcare professionals [HCPs] toward systems used in describing the safety of medications use during pregnancy. A cross-sectional self-administered survey was conducted in 4 tertiary hospitals in Riyadh, Saudi Arabia between March and May 2012. The targeted HCPs were physicians and pharmacists. The survey was validated and contained 4 main sections. Descriptive statistics were used to report responses to the survey's questions. A total of 393 HCPs responded to the survey, with a response rate of 97%. Half of the respondents were physicians. Of the participants, 60% were males. Most respondents [66%] stated that they have prescribed/dispensed a drug that may cause teratogenicity. Moreover, 87% of the respondents [48% pharmacists and 39% physicians] were aware of the Food and Drug Administration [FDA] pregnancy category, and most [72%] found it helpful. Only 11% of the participants strongly agree to use the European Medicine Agency [EMA] system for pregnancy category system as their main reference. In general, HCPs in Saudi Arabian hospitals have good knowledge of and attitudes toward pregnancy category systems, with more familiarity with the FDA system. The FDA system is preferred over the EMA system

Epstein-barr virus in multiple sclerosis

Multiple sclerosis [MS] is an inflammatory disorder of the central nervous system. Many diseases are associated with Epstein-Barr virus [EBV] infection, such as infectious mononucleosis and many types of malignancies, and it is thought to be related to some diseases of autoimmune origin, such as rheumatoid arthritis, systemic lupus erythematosis, and others. The present study aimed to assess EBV in patients with MS. This case-control study was conducted from October 2012 to September 2013 on 75 MS patients and non-MS controls. Both were tested quantitatively for immunoglobulin G [IgG] antibodies against Epstein-Barr nuclear antigen-1 [EBNA1] and viral capsid antigen [VCA] using the enzyme linked immunosorbent assay technique. Seventy MS patients [93.3%] were positive for EBNA1 IgG compared with 68 controls [90.7%]. In MS patients, the mean EBNA1 IgG serum level was 310.91 [ +/- 131.05] U/ml; meanwhile, among controls the mean serum EBNA IgG level was 177.81 [ +/- 104.98] U/ml. All patients with MS were positive for VCA IgG, whereas only 60 [80.0%] controls were positive. In the MS group, the VCA IgG mean level was 302.19 [ +/- 152.11] U/ml compared with 167.94 [ +/- 111.79] U/ml in controls. The differences in the serum levels of both markers between the two groups were statistically significant [P<0.001]. EBV proved to have a unique immunological pattern in MS patients when compared with non-MS controls. Further studies for more confirmation of the relation between EBV and MS on a large scale are recommended

Medications use among pregnant women in Ethiopia: A cross sectional study.

Despite lack of scientific evidence about the safety of some medications, the reported use of medications during pregnancies has increased. This may lead to adverse reproductive outcomes, due to potential risk to the mother and the fetus. In contexts of most developing countries including Ethiopia, it is difficult to elucidate medications use prevalence during pregnancy and their relative contributions to birth defects for several reasons. Institutionbased cross sectional study was conducted in Tertiary care hospital Ethiopia. Current medication use data were collected by reviewing patients' charts in the antenatal care follow up clinic, chronic care (internal medicine) as well as psychiatry clinic and by interviewing pregnant women using semi-structured questionnaire. Medications were classified using the United States Food and Drug Administration pregnancy risk classification system. A total of 339 women were included in the study; of which 187 (55.2%) had used at least one prescription and 162(52.2%) had used over the counter medications during pregnancy. The majority of the medications were antibiotics (42.5%) and analgesics (40.1%). 57(16.8%) and 24(7.1%) of medications were prescribed from category D and X respectively. Out of 187 (55.2%) prescription medications used, 51 (15.0%) were obtained without prescribers order. Majority (70.8%) of the women did not have awareness regarding risks associated with self medication. Prescription medications use was 0.08 times less among women with a co-morbidities (AOR 0.08(.05, 0.13), p=0.001) and 2.5 times higher among women from rural areas (AOR 2.53 (1.15, 5.56); P=0.02). Compared to employed women, over the counter medications use were 1.9 times more among house wife women (AOR1.87 (1.12, 3.09), p= 0.02) and about thrice higher among merchant women (AOR 2.88(1.10, 7.55), p= 0.03). Likewise, presence of medical problems was found to have 60% protective against OTC medications use (AOR 0.40 (.26, 0.64), p=0.01). The overall medications use during pregnancy was found to be high. Medications use without prescribers order was common and potentially harmful medications (category-D and X) use appeared to be higher in all trimesters. The findings of this study argue in favor of prescribing some potentially harmful medications which could have been avoided during pregnancy. Majority of the women lacked awareness about the potential risks associated with medications use in pregnancy without prescribers order.

Knowledge on adherence and safety of the oral contraceptive pill in Saudi women

To assess knowledge regarding adherence and safety of oral contraceptive pills [OCP] in Saudi women. We conducted a cross-sectional prospective study in an outpatient pharmacy at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from April to September 2011. Participants were healthy women aged >/= 18 years with an OCP prescription for contraception. We used a validated questionnaire to assess their knowledge regarding adherence and safety of OCPs. Four hundred and sixty women participated. Most [79%] knew to take an extra pill if they missed one in less than 12 hours, but only 6.5% knew they also had to use extra protection for the next 7 days if it was more than 12 hours. Multiple logistic regression analyses indicated that years of contraceptive use and educational level are predictive factors of better knowledge regarding adherence. Few were aware of the action if they experienced diarrhea for more than 12 hours [10%] or vomiting within 2 hours [13.5%] of taking an OCP. Only 30% knew of the adverse effects of smoking while on OCPs. Weight gain [51%] was the most commonly reported side effect. Most Saudi women taking OCPs have limited knowledge of its correct use regarding missing pills, vomiting and diarrhea, and poor awareness of the effects of smoking while using OCPs.

Information-seeking behaviors and attitudes of physicians toward drug information centers in Saudi Arabia

To assess the drug information-seeking behavior of physicians in Saudi Arabia and the information resources they were using to obtain information about new drugs. The physicians' awareness of the existence of drug information centers [DICs] and their attitudes toward these centers were also investigated. Physicians were also surveyed concerning their future information needs. The study was conducted between September 2002 and June 2003. A questionnaire was sent to 2000 registered physicians. Data were collected on demographics, drug information resources currently used by physicians, attitudes towards DICs and future information needs. Response rate was 65.9%. Only 70% of the physicians were aware of the existence of DICs in KSA and 33.9% have used this service before with request rate of 0.3/month during the last 6 months prior to survey. Physicians relied heavily on books [79%], periodicals [59.2%], symposia [55.1%] and pharmacists [35.3%]. Physicians searched for information 17.5 times during the last 6 months and only 57.3% were using computers and 40% had no access to the Internet at work. Physicians in KSA had passive attitudes toward DICs. These centers are under-utilized by health care professionals, in part due to the lack of awareness of their existence by physicians. Drug newsletters and continuing education programs in information-retrieval and evaluation based on evidence-based medicine techniques to promote DIC's services should be instituted

Study of factors affecting left ventricular function and their relation to volume overload in haemodialysis patients

Technological innovations in haemodialysis [HD] have improved its quality and safety but cardiovascular morbidity and mortality still poses a great risk. Proper fluid removal is a critical component of HD, as both under and over hydration are associated with deleterious consequences. However, there is no single accurate measure for adequacy of dialytic fluid removal and assessment of dry weight is largely empirical. This may rely on clinical assessment, biochemical markers as natriuretic peptides, dilution methods, measurement of inferior vena cava diameter [IVCD], blood volume monitoring and bioimpedance analysis [BIA]. Plasma BNP was recently reported to be a sensitive marker both for volume overload and ventricular hypertrophy and/or dysfunction. We aimed to study some pathogenetic factors and diagnostic parameters of left ventricular hypertrophy and/or dysfunction in end- stage renal disease [ESRD] patients on maintenance HD. Emphasis was made on the utility of echocardiographic and BIA measurements in monitoring the development and assessment of volume overload during the inter- dialytic interval. Two groups of subjects were studied: 50 patients with ESRD on maintenance HD for >/= 6 months, and 15 age and sex matching controls. Patients were subjected to full clinical assessment, ECG, predialysis measurement of serum fasting blood sugar, creatinine, calcium, phosphorus, intact parathyroid hormone, lipid profile, uric acid, haemoglobin concentration and haematocrit value. Dialysis dose was assessed by urea reduction ratio and Kt/V. Plasma BNP, echocardiographic studies [for presence and geometric pattern of left ventricular hypertrophy, systolic and diastolic dysfunction and measurement of IVCD and right atrial pressure] and BIA were all done on two occasions 3 days apart: after termination of the end- of- the week HD session and before the start of the first session in the next week. Controls were subjected to assessment of clinical state, plasma BNP, and BIA. Both post- and pre- dialysis plasma BNP levels in patients were significantly higher when compared with the single plasma BNP reading in controls. Extracellular water [ECW] and its percent to total body water [ECW%] were higher in patients [both post- and pre- dialysis] compared to controls. The differences were statistically significant, except for post- dialysis ECW. The pre- dialysis values of mean velocity of circumferential fiber shortening, stroke volume, cardiac output, E/A ratio, Right atrial pressure, IVCD, ECW and ECW% were all significantly higher compared with the post- dialysis values. Left ventricular hypertrophy [LVH] was found in 47 [94%] patients, concentric LVH being the most frequent pattern [in 60%]. Pre- dialysis left ventricular mass index [LVMI] showed a statistically significant positive correlation with serum phosphorus, calcium phosphorus product, and plasma BNP. Pre- dialysis plasma BNP had a statistically significant negative correlation with pre- dialysis ejection fraction and fractional shortening. Volume overload plays a key role in the pathogenesis of LV hypertrophy and/or dysfunction in HD patients. BIA and IVCD are useful adjunctive measures for assessment of hydration status, keeping their limitations in mind. Plasma BNP concentrations have limited potential for the assessment of hydration status in HD patients, but it may be useful to have a baseline measure when the patient is at dry weight. Whether BNP can be used as a bedside test in the dialysis unit to measure adequacy of volume removal remains to be determined

Detection and differentiation of entamoeba histolytica and entamoeba dispar isolates in clinical samples by PCR

A total of 140 out of 180 outpatients attended MISR University for Science and Technology Hospital complained of abdominal pain, diarrhoea and/or dysentery. Stool examination showed 47 [33.6%] had Entamoeba sp., 36 [25.7%] had cysts and 11 [7.9%] had trophozoites. Of 40 asymptomatic ones, 4 [10%] had cysts. A total of 51 positive stool samples for Entamoeba sp. [40 cysts and 11 trophozoites] were tested by Ne-sted Polymerase Chain Reaction [N-PCR] and Restriction Enzyme Digestion [RED] to clarify true E. histolytica from E. dispar. The results showed that 9/51 [17.6%] had E. dispar, while 31 [60.8%] had E. histolytica and 11 [21.6%] had dual infection with both E. histolytica and E. dispar. All E. histolytica PCR proved cases were from the symptomatic group, 11 had trophozoites and 34 had cysts. Thus, the result showed the potential use of molecular tools in detection of E. histolytica and E. dispar, and is a promising tool for epidemiology, particularly to differentiate pathogenic and non pathogenic Entamoeba sp

Effect of abouthiouline, a novel drug with therapeutic potential as antithyroid, on some biochemical and hematologic parameters in mice and rats

Abouthiouline [1-Cyclohexyl-3[3-quinolyl]-2-thiourea] is a novel compound with antithyroid activity. Abouthiouline [ABL] was designed based on structure-activity relationships [E-state indexes] aimed at reducing the antioxidant properties of the compound by modification of acyclic thiourylene moiety. Antioxidant effects of currently available treatments such as propylthiouracil [PTU], methimazole [MTM] are associated with an incidence of agranulocytosis and aplastic anemia. In the present study, the preclinical toxicology of ABL was determined in mice and rats and compared with two reference compounds, namely, propylthiouracil, methimazole. Following short-term administration [7 days] to mice, ABL had minimal effects on biochemical parameters, although significant reductions in both total protein and albumin were noted. Long-term studies [30 days] in rats revealed significant effects of Abouthiouline, propylthiouracil and methimazole on serum electrolyte and glucose levels. Abouthiouline had no detrimental effects on hematologic parameters. However, total WBC count [propylthiouracil] and neutrophil levels [propylthiouracil and methimazole] were significantly decreased among other treatment groups. The results of this investigation suggest that Abouthiouline is a promising new antithyroid therapy with a reduced risk of hematologic toxicity that is associated with PTU and MTM. Further studies are warranted to assess the safety and efficacy of Abouthiouline

Conservative versus radical surgery for treatment of uncomplicated hepatic hydatid cysts

This work evaluated both radical and conservative surgical approaches in the management of hepatic hydatid cyst. A total of 32 cases with uncomplicated hepatic hydatid cysts were divided into 2 groups according to the type of surgery. Patients in the first group [n=18] were subjected to conservative surgery in the form of endocystectomy, omentoplasty with or without drainage. Cases in the second group [n= 14] underwent radical surgery that included closed pericystectomy, open pericystectomy, wedge hepatic resection or segmentectomy. The results showed that the use of rib cage retractor could avoid the need for thoracotomy incision with its morbidity to manage cysts at the dome of the liver. The mean operating time in GI [140.15 +/- 38.30 mm] was significantly shorter than in GII [190.4 +/- 50.2 mm], with P<0.05. The need of blood transfusion in GI [16.7%] was lesser than in GII [35.7%], but the difference was statistically not significant. The postoperative pain, evaluated by the number of IM analgesic injection was significantly lower in GI [7.2 +/- 3.3] than in GII [9.9 +/- 3.9] with P<0.05. Wound complications were more observed in GII. There was only one reported recurrence in G I in a case with multiorgan cysts that did not receive perioperative anthelmintic chemotherapy. So, conservative surgical management of uncomplicated hepatic hydatid cysts with perioperative anthelmintic chemotherapy supposed to be a simple, safe and effective approach. Its efficacy is comparable to radical surgical procedures with much less morbidity

Co-infection with cryptosporidium parvum and cyclospora cayetanensis in ummunocompromised patients

Forty nine stool specimens collected from severe diarrheic patients. Eight were suffering from Hodgkin's lymphoma, and the rest were suffering from acute lymph plastic leukaemia. All were examined microscopically for protozoan parasites mainly, Cryptosporidium parvum and Cyclospora cayetanensis. Of the patients, 34 [69.4%] were positive and 15 [30.6%] were negative by both microscopy and nested PCR. An additional 12 [24.5%] who were negative by microscopy were positive by nested PCR. Stool examination revealed 16 cases with C. parvum, and 6 with C. cayetanensis, and 3 cases showed mixed infection. The results were compared with the established nested PCR assay to detect DNA directly from stool specimens. The patients <3 years old more affected by Cryptosporidium infection, unlike Cyclospora sp. Infection was in older age groups, which reflected the modes of parasite' transmission. Diarrheal illness was stronger for Cyclospora than for Cryptosporidium. After the extraction of DNA from stool, a 402-bp fragment of C. parvum, and 602 bp fragment of C. cayetanensis was amplified. The amplified products, 194-bp DNA fragment for C. parvum, and 306 bp DNA fragment of C. cayetanensis were used for the second run. This study indicated that primers were specific for DNA of C. parvum and C. cayetanensis. PCR detected a total of 22 [44.9%] positives for C. parvtim infection [6 negative by AF stool examination], and 12[24.5%] positives for C. cayetanensis. Infection [6 negative by AF stool examination], 7[14.3%] showed mixed infection [4 negative by AF stool examination], all microscopic negative specimens were positive by successive stool examination. Microscopy exhibited sensitivity of 72.7% for C. parvwn, 50% for C. cayetanensis and 100% specificity for both parasites compared to 100% sensitivity and specificity with PCR. So, PCR is more sensitive and easier to interpret but required more hands-on time to perform and is more expensive. However, PCR batch analysis reduces the cost considerably

Incidentally discovered adrenal masses: report on 20 cases and update of the literature

To report our experience with diagnosis and management of twenty cases of adrenal incidentaloma. Over a period of 7 years, adrenal masses were detected incidentally in 20 cases [13 males and 7 females] during imaging work-up performed for extra-adrenal complaints. Their ages ranged between 15-68 years [mean 48 years]. The reasons for an abdominal imaging procedure were vague abdominal pain in 8 cases [40%], renal colic in five cases [25%]; biliary colic in 4 cases [20%], post-surgery follow-up in two cases [10%] and acute abdomen in one case [5%]. The most common clinical abnormalities were hypertension [5 cases], obesity [4 cases] and diabetes mellitus [4 cases]. Diagnosis was made by ultrasound and confirmed by CT. The longest diameter of the masses ranged from 2 to 12 cms. The right side was affected in 16 cases and the left side in 4 cases. Biochemical work up included determinations of serum electrolytes, lipids and hormonal studies. Percutaneous adrenal biopsy was done in 5 cases under ultrasound guidance. Abnormal hormonal functions were detected in four cases. Seven cases had adrenal cysts, 6 cases had adrenal carcinomas, 3 had pheochromocytoma and 3 cases had adrenal metastases with, unknown primary tumors and one had subclinical Cushing disease. Surgical adrenalectomy was performed in 9p…tients [45%] for malignancy in 6 cases [one of them had adrenal metastasis] and for pheochromocytoma in 3 cases. Eight out of those nine cases who underwent adrenalectomy had masses with diameters greater than 5 cm and one had adrenal cyst 4 cm in diameter on CT proved to be pheochromocytoma. Imaging characteristics suggestive of malignancy were found in six cases. In two cases surgery was indicated but not performed because it was refused by one patient and was excluded for extensive metastases in another one. We concluded that, Every patient with an adrenal incidentaloma has to be investigated thoroughly to detect malignancy and subtle hormonal overproduction, to select the cases for surgical treatment. All cases of adrenocortical carcinomas were more than 5 cm in diameter. For prophylactic purposes, adrenal incidentalomas > 5 cm should be treated by surgery, while the smaller ones could be followed-up. Percutaneous adrenal biopsy was generally safe and accurate diagnostic procedure

Adrenal cystic masses: report of ten cases and suggested algorithm for therapy

Purpose: To report our experience in diagnosis and treatment of adrenal cysts in 10 cases. Patients and Over 7 years period adrenal cysts have been diagnosed in 10 patients [7 males and 3 females]. Their ages ranged between 25 n 68 years. Eight cases were between 50 and 68 years. Six cysts were detected incidentally during imaging work-up performed for extra-adrenal complaints. Three cases presented by flank pain and only one had severe hypertension. Diagnosis was made by ultrasound [US] in all cases and confirmed by computed tomography [CT] in six cases. The longest diameter of the cysts ranged from 3 to 12 centimeters. The right side was affected in 8 cases and the left side in 2 cases. All cases had unilateral cysts. Biochemical work up included determinations of serum electrolytes, lipids and hormonal study. Adrenal ultrasound-guided FNAB was performed in all cases. Six cases had simple non-functioning adrenal cysts, two had infected adrenal cysts one had cystic pheochromocytoma and one had adrenal carcinoma. Surgical adrenalectomy was performed in three patients [30%]. The indications for operation were pheochromocytoma in one patient, symptomatic adrenal cyst with diameter greater than 5 cm in another one, and adrenal carcinoma in a third patient. Imaging characteristics suggestive of malignancy were found in only one proved to have adrenal carcinoma. Cysts recurred in five cases after FNAB. Small, asymptomatic, non-functional cysts with benign characteristics may be treated conservatively with regular follow-up by US or CT. Symptomatic benign nonfunctioning adrenal cyst may be managed by aspiration alone. If the cyst recurs and is asymptomatic, it may observed. If a symptomatic cyst recurs, it may be reaspirated or excised. Malignant adrenal cysts should be treated by adrenalectomy

Double atrial potentials as a marker for isthmus block during ablation of atrial flutter

Assessment of success is an integral part in atrial flutter ablation. This work is concerned with evaluating the added value of recording double potentials along the ablation line induced to interrupt the macro-reentrant circuit of atrial flutter. Atrial flutter was ablated in 24 consecutive patients, 7 males and 7 females, their ages ranged from 10-65 years, with mean age of 37 +/- 12.5 years. The ablation was done through burning a continuous line across the cavo-tricuspid right atrial isthmus. In all patients pace-mapping indicated complete bidirectional isthmus block, we tried to record double potentials along the ablation line during pacing from the coronary sinus ostium. The patients were followed up for 6 months, recurrent cases were reablated. the acute success rate was 100% in both the initial and the second procedures. Nine recurrences [37.5%] occurred during the period of follow up, which were reablated; none of the reablated cases had any recurrence during six months of follow up, with overall late recurrences of nine patients out of 33 procedures [27%]. Whenever double atrial potentials were recorded along the ablation lines, there was no recurrence [specificity of 100%], but in cases in which these potentials were not recorded, it did not predict recurrence except in 40% of cases [sensitivity 60%]. Predictors of late recurrence, in this study, were age of the patient and Duration of symptoms. We compared between 4 and 8 mm tip ablation catheters, it turned to be that the recurrence and the procedure duration was lower with the use of 8 mm tip catheters. Patient with structural heart disease in this study were older, with more duration of symptoms and their procedures were longer. In conclusion, there was an added value of recording double atrial potentials to the conventional mapping technique used to identify bidirectional isthmus block in patients with atrial flutter. In addition, 8 mm tip catheters were considered safe and effective in the term of reducing the time of the procedure and recurrence rate specially when combined with SVC approach. Abbreviations: SVC: superior vena cava

Pre-operative MRI evaluation of local disease extent in residual / recurrent colorectal and anal cancer

To determine pre-operative MRI accuracy in assessing local disease extent in residual / recurrent colorectal and anal cancer by comparing MRI assessment and staging examination under anaesthesia, Eighteen consecutive patients with recurrent [12 patients] or residual [6 patients] underwent examination under anaesthesia and MRI using a phased array pelvic coil. .Analysis of eight specific anatomical regions for tumor involvement on MRI was performed Findings at examination under anaesthesia and biopsy were recorded. The MRI and examination under anaesthesia findings were correlated with findings at surgery and histopathology. MRI accuracy in determining tumor invasion for all sites assessed were [90%,], sensitivity was [85%,], specificity was [91%], positive predictive value [PPV] was [75%] and negative predictive value [NPV] was [95%]. For those anatomical sites evaluated by both examination under anaesthesia and MRI, MRI was superior to examination under anaesthesia, with an accuracy of 90% Vs 74%. MRI is an accurate technique for assessing disease extent in recurrent / residual colorectal and anal cancer

Can the rate of cesarean section be reduced?

To look into all cases with previous one cesarean section who were cared for and delivered at Armed Forces Hospital, Riyadh, between January 1990 and December 1998, to determine its prevalence, final method of delivery, and outline measures of reducing its incidence. Retrospective analysis of hospital records of all women with previous one cesarean section who had either a repeat cesarean section or delivered vaginally after cesarean section. Between 1990 and 1998, 61,060 mothers were delivered. Two thousand five hundred and seventy eight patients had one previous cesarean section. They represented 3.5% of the total number of deliveries. Nine hundred and sixty eight [37.5%] cases had repeat cesarean section. Of the 1610 [62.5%] mothers who achieved vaginal delivery, 102 [6%] had ventouse, 42 [3%] had forceps and 22 [1%] had an assisted breech delivery. Rupture of uterine scar was reported in 15 cases. There were no maternal or perinatal deaths. Patients with one previous cesarean section are three times more likely to have a cesarean section as compared to mothers with unscarred uterus. Reducing the overall cesarean section rate is possible through a closer look at the primary indication for the first cesarean section. A protocol is needed to allow more cases with one or more previous cesarean section to have trial of vaginal delivery under close monitoring and involve the senior staff more in the diagnosis and management of cases of dystocia and the use of Oxytocin when indicated