Metachronous metastatic renal cell carcinoma to the jejunum presenting with massive lower gastrointestinal bleeding

Metastatic renal cell carcinoma [MRCC] is a rare cause of massive lower gastrointestinal bleeding [LGIB]. We report a 51-year man who underwent left nephrectomy for renal cell carcinoma [RCC] 6 years ago. presenting with massive LGIB. Preoperative abdominal computed tomography [CT] revealed small bowel mass. Exploration of the abdomen revealed jejunal mass. Resection of the mass along with the jejunal segment with end-to-end anastomosis was performed. Histopathology of the jejunal mass confirmed MRCC. MRCC should be expected as a source of massive LGIB in a patient with history of RCC. Surgical intervention should not be delayed in a hemodynamically unstable patient and persistent bleeding

Pediatric pulmonary services in Saudi Arabia

The purpose of this study was to assess the available pediatric pulmonary services, in terms of workforce, resources, and distribution across Saudi Arabia. This would help in proper utilization of resources and direct future planning. A cross-sectional survey among pediatric pulmonologists registered in the Saudi Thoracic Society. Among 43 practicing pediatric pulmonologist in Saudi Arabia, 29 have responded to the survey [response rate of 67.4%]. The majority of practicing pediatric pulmonologists were young graduates with less than 5 years' experience [44.8%] and were North American training programs graduates [69%]. The majority of the respondents [51%] were located in Riyadh, 27% in Jeddah, 14% in the Eastern region and 3% in Madinah and Al-Majma'a. Most of the respondents had access to basic diagnostic tools required in the subspecialty, a majority of them [85%] lack dedicated pediatric pulmonary function laboratories. Nearly, 80% of the hospitals performed less than 50 flexible bronchoscopies/year. Pediatric pulmonology is a growing subspecialty in Saudi Arabia with well-trained and experienced physicians. Our study represents an overview of the available pediatric pulmonology services in Saudi Arabia, which would help in future planning and better utilization of the available resources

Haemodialysis - associated septecaemia: Incidence, causes and outcome

The aims of this study were to investigate the incidence, causes, associated conditions, outcome and therapy of hemodialysis-associated septicaemia. The files of all 61 haemodialysis patients who developed septicaemia from 01.01.2000 to 31.12.2001 were studied. The following parameters were analyzed - age, gender, vascular access lifespan, type of access, causative organism, therapy, salvage or loss of vascular access, mortality, Kt/V, haemoglobin, albumin, underlying cause of renal failure, need for hospitalisation and duration on dialysis. Patients who did not develop septicaemia over the same period acted as controls. There were 78 episodes of septicaemia in 61 patients. The overall annual incidence of septicaemia was 14%. The annual incidence differs accordingly to type of vascular access, being 2.8% for arteriovenous fistula [AVF], 35% for permanent catheter [PC], 42.5% for jugular catheter [JC] and 100% for femoral catheter [FC]. The commonest causative organism was staphylococcus species [52.6%] followed by pseudomonas [10%] and acinobacter [4%]. Haemoglobin and albumin levels were lower in the septicaemic group but this did not reach statistical significance. However, there were statistically significant differences in Kt/V [P>. 0003], presence of diabetic nephropathy [P>. 050], catheter vs. AVF [P>. 0001]. No difference could be noted in relation to age or sex. The duration on dialysis was significantly greater in the control group [47.7 months vs. 17.8 months>.005]. The mortality rate was 6.5%, the hospitalisation rate was 48.7% and 56.4% of the access catheter were preserved. Seventy-five percent of the patients who died were diabetic [compared to 38% in those who survived]; their mean age was 57.7 years compared to the mean age of the whole group of 52.5 years. The mean duration on dialysis was 3.1 months compared to 17.8 months in the surviving patients. The therapy consisted of vancomycin alone in 45 episodes, vancomycin based in 14 episodes, gentamycin alone in 6 episodes and others in 11 episodes. Septicaemia is common in haemodialysis patients. It is particularly common when catheter accesses are used. Staphylococcus species is the commonest causative organism. Early aggressive therapy with vancomycin with or without gentamycin reduces the mortality, morbidity and access loss