RESUMO
Laparoscopic fundoplication can alter the natural course of Barrett's esophagus [BE]. This study was undertaken to assess this role in patients with non-complicated BE. From October 2004 to October 2009, 43 patients with BE [32 men and 11 women] underwent laparoscopic Nissen fundoplication surgery in the Department of Surgery at Minia University Hospital. the median age of these patients was 46 years [range: 22-68 years]. Patients with high-grade dysplasia, invasive cancer, or previous antireflux surgery were excluded. All 43 patients had gastroesophageal reflux symptoms. Heartburn was present in all patients, regurgitation in 41 [95.3%], dysphagia in 8 [18.6%], retrosternal pain in 30 [69.8%], upper gastrointestinal hemorrhage in 6 [13.9%], and respiratory symptoms in 19 [44.2%]. Nissen funcoplication was performed in all patients. Thirty-four patients [79.1%] had concomitant hiatal hernia and nine patients [20.9%] had low-grade dysplasia. The median follow-up period was 25.6 months. There was significant improvement of symptoms after surgery [P<0.05]. Eight [18.6%] of those with short-segment BE had total regression and four [9.3%] of those with long-segment BE had a decrease in total length. Among the nine patients with preoperative low-grade dysplasia, dysplasia disappeared in seven, remained unchanged in one, and progressed to in situ agenocarcinoma in one patient. Laparoscopic fundoplication succeeded in controlling symptoms but had unpredictable effect on dysplasia and regression of BE. Laparoscopic fundoplication does not eliminate the risk of developing esophageal adenocarcinoma and therefore, endoscopic follow-up should be continued in these patients
RESUMO
To investigate the impact of associated extra-abdominal injury on morbidity and mortality in poly-traumatized patients with blunt abdominal trauma. This analysis included poly-traumatized patients with blunt abdominal trauma treated at the Emergency Unit of Minia University Hospital and Misr University for Science and Technology Hospital, Minia, Egypt, between March 2006 and March 2008. This study included patients aged 4-73 years with injury severity score [ISS] more than 18 and indicated for surgical intervention. Data were analyzed with details of injury, treatment, complications, and mortality. Inclusion criteria were met by 94 patients with mean ISS of 29.3 +/- 6.4. Most frequent injuries were seen in the spleen [61.7%] and liver [47.9%]. Chest trauma represents most common extra-abdominal trauma [67%] Thirty-six patients [38.3%] died during their hospital stay. Most frequent reasons for death were hemorrhagic shock [27.8%], acute respiratory distress syndrome [27.8%], and head trauma [22.2%]. There was a positive relationship between liver injury and mortality, which not found in splenic injuries. Significantly more deaths were attributed to primarily extra-abdominal injuries [66.7%] and then to intra-abdominal injuries [19.4%]. In 5 patients [13.9%], a combination of intra- and extra- abdominal injuries caused post-traumatic death. Extra-abdominal injuries add to the morbidity and mortality from blunt abdominal trauma in poly-traumatized patients. Routine computerized tomography scanning can minimize negative abdominal exploration and facilitate better management of extra- abdominal injuries