Diaphragmatic rupture by blunt trauma: a report of three cases

We report three cases of diaphragmatic rupture due to blunt trauma managed in our hospital during the period from September 1995 to January 2000. The injuries were due to motor-vehicle accidents. All patients were males, with ages ranging from 25 to 80 years. Two patients presented acutely with left hemidiaphragmatic rupture and stomach herniation into the thorax. Both suffered associated skeletal injuries. The third patient presented 4 years after the traumatic event with right diaphragmatic hernia that contained strangulated bowel. Postoperative complications relating to the diaphragmatic hernia occurred in the patient that presented late. These three cases underscore the importance of plain chest radiography [CXR] in the early diagnosis of this type of injury

Laparoscopic cholecystectomy with reduced abdominal pressure in ASA grade 111 and 1V patients

Increased intra-abdominal pressure [IP] and carbon dioxide absorption during laparoscopic cholecystectomy can lead to haemodynamic decompensation and cardiovascular compromise due to impaired venous return and acidosis. We studied effects of increased and reduced IP on cardiac and respiratory functions in 15 patients undergoing laparoscopic cholecystectomy. The effect of reduced IP [T3] from the insufflation pressure [T2] and pre-insufflation pressure [T1] on mean blood pressure [MBP], heart rate [HR], arterial oxygen saturation [SaO2], end tidal carbon dioxide concentration [ETCO2] and mean airway pressure [MAP] were recorded in 15 patients. The patients were operated at lower IP with the help of an anterior abdominal wall lift device. There were no significant changes in SaO2 and HR. MBP increased by up to 69% at T2 and by up to 27% at T3. MAP increased by up to 49% at T2 and by up to 14% at T3. ETCO2 increased by up to 27% at T2 and by up to 12% at T3. All these increases were with reference to T1. It is proposed that by operating under reduced IP, the cardio-respiratory functional changes can be minimised, thus keeping the haemodynamics and respiratory physiology close to their pre-insufflation levels. It is suggested that patients with poor cardio-pulmonary status may benefit if operated under lower IP

incidence of helicobacter pylori in consecutive endoscopies of the upper gastrointestinal tract

In a seven months period upper gastro-endoscopy was performed on 200 consecutive patients referred to Fujeirah hospital; 22 of whom had duodenal ulcer. Brush smears of the gastric mucosa revealed Helicobacter pylori in 164 samples [82%]. Treatment with amoxycillin eradicated the bacteria in all patients; however, it reemerged at the endoscopic examination performed 4 weeks after therapy. In the group on H2 receptor antagonists only 25% of patients showed eradication of bacteria which reemerged at the second endoscopic examination. Antacids did not have any effect on the eradication of the bacteria. Biopsy at sigmoidoscopy revealed no organisims. Helicobacter pylori is present in a significantly large number of people in the UAE with dyspepsic symptoms. Recolonization is common after eradication. A causal relationship though difficult to prove is suggested

Clinical presentation of breast cancer in the UAE

A retrospective study of 153 patients with cancer of the breast analysed according to age, sex, nationality, family history and mode of presentation is reported. 76 [49.7%] patients were less than 43 years and premenopausal. The left breast was more frequently involved 82 [53.59%], and only 32 [25.6%] were clinical stage I or II. 22 [18.97%] presented within two months of awareness of symptoms. 99 [86.84%] patients had tumours more than 2 cm and a painful lump causing discomfort forced 77 [51.68%] patients to seek medical attention. The majority breast fed and bore children and 18 [15.15%] were lactating mothers. The turnours seemed to grow aggressively when discovered at a younger age

Preliminary report on gastric brush cytology as a screening procedure for gastric cancer

Carcinoma of the oesophagus and stomach in the United Arab Emirates are common diseases and most of the cases who present are late stages with very poor five-year survival rates 216 patients with symptoms referable to the upper GIT were visualised endoscopically; gastroscopic brush smears and biopsies were collected and results of 202 paired histologic and cytologic study were correlated. Cytologic examination increased the detectability of gastric dysplasia from 2% by biopsy alone to 4% by combined biopsy and cytology, and intestinal metaplasia from 5% to 8.4%. The overall cytologic accuracy for diagnosis of malignancy was 80%. Cytologic typing accuracy for malignant cases was 100%. The value of gastric cytology to increase detectability of premalignant changes is emphasized

Upper gastrointestinal endoscopy in Ajman

This review of the results of upper gastrointestinal tract [GIT] endoscopy highlights the prevalence of peptic ulcer disease [PUD] as the commonest diagnosis in Ajman. The commonest age affected is from 30 - 35 years. Unskilled workers, army personnel and government employees are commonly affected. Bangladeshi expatriates seem to neglect their symptoms and present mainly with complications of PUD. The number of endoscopies performed on females are less than in males. The above factors and variations are discussed