Outcome of colonic fistula surgery in the modern surgical era.

BACKGROUND: Various conditions lead to the development of colonic fistulas. Contemporary surgical data is scarce and it is unclear whether advances in surgical care have impacted outcome. The aim of the present study was to review the short- and long-term outcome of patients treated surgically for colonic fistula over an 8-year period at a tertiary institution. METHODS: A retrospective review was performed, focusing on the type of operative interventions, short- and long-term complications, length of hospital stay, readmission rate, mortality rate, and fistula recurrence. RESULTS: Forty-five patients were treated for colonic fistula. The most common etiology was diverticulitis (74%). Fistula type was colovesical (58%), colocutaneous (18%) and colovaginal (15%). Laparoscopic resection was performed in 42% of cases. An intraoperative complication occurred in 4%. A primary anastomosis was performed in 96% of patients and 10 (23%) had a temporary stoma. Median length of hospital stay was 6 days. Postoperative complications were common (47%) and wound infection was noted in 20% of patients. The readmission rate was 29% and the 90-day mortality was 4%. All patients healed their fistula with no recurrences noted during a median follow-up of 37 months. CONCLUSIONS: Surgical intervention healed the majority of patients with colonic fistula. However postoperative complications were common and readmission occurred in one-third of the cases. Laparoscopic excision was feasible in nearly half of the patients.

Acute renal failure in the State of Qatar: presentation and outcome.

Despite major improvements in health care, acute renal failure is still one of the main prognostic factors in terms of patient mortality and long-term morbidity. This cohort prospective study to evaluate the patterns and outcomes of renal failure in Qatar was performed between January and June 2005. Of the 213 patients followed prospectively from referral to the end of their hospitalization, 66.7% were males and 33.3% females. Their overall mean age was 60 years; the majority were referred from critical care units. Comorbidity was present in 87% of all patients. Volume depletion, hypotension, and sepsis were the main predisposing factors for renal failure. Eighty three patients (39%) needed renal replacement treatment and 130 (61%) were treated conservatively. The majority of critical care patients needed dialysis. Overall mortality was 23.9%, 7% needed chronic dialysis, and 69.1% were discharged with normal or mild renal impairment. This study showed that acute renal failure was a major factor affecting patient mortality in Qatar. Early treatment of predisposing factors may improve overall patient outcomes.

Prevalence of hydatid cysts in livestock from five regions of Jordan.

When the prevalences of cystic echinococcosis in indigenous sheep, goats, cattle and camels from five regions of Jordan were investigated, from March to December 1992, they were found to be 12.9%, 12.7%, 0.9% and 11%, respectively. They were substantially higher in sheep from Karak (27.6%) and in cattle from central Jordan (18.0% in Amman and 14.3% in Sahab) than in the same animals in other regions. Age-intensity data indicated that the parasite population is endemic in sheep and cattle and hyperendemic in goats. Infection rate increased steadily with age in sheep, but became constant in goats and cattle when they were about 2 years of age. The most common locations of cysts were the liver in sheep and goats and the lungs in cattle. Co-infection of the liver and lungs was common in sheep and cattle. Although the majority of the sheep, cattle and goats had 1-10 cysts, 20.4% of the sheep and 22.2% of the cattle had 11-50 and 11-30 cysts, respectively. Although 38.1% of the cysts in sheep were fertile, only 8.7% of the cattle cysts and 4.5% of the goat cysts were in this condition. The overall mean number of protoscolices/sheep cyst was 2.7 x 10(3); although the liver cysts had more protoscolices than the lung cysts (3.2 x 10(3) v. 1.9 x 10(3)/cyst), more of the lung cysts were viable (71.1% v. 62.3%). Some 0.2% of 13,436 sheep and 6.1% of 786 cattle imported live into Jordan were infected with hydatid cysts; 16.3% of the sheep cysts (61.4% viable) and 9.6% of the cattle cysts (76.1% viable) were fertile.

Measles associated hepatobiliary disease: an overview.

In this report the literature on all cases of documented measles with hepatobiliary disease was reviewed to describe the characteristics of measles associated hepatitis. We found 27 patients described. Their age ranged from 9 to 59 years. Male to female ratio excluding military facilities was 1:1. The clinical and laboratory presentation appeared to follow one of two patterns. The first was suggestive of hepatocellular dysfunction characterized by aminotransferase elevation. It was encountered in 24/27 cases, seven of them with atypical measles. This form of liver disease tended to be asymptomatic. It appeared early and resolved in a few days. The second pattern was characterized by cholestasis and jaundice. It was described in three cases. This type of hepatitis became apparent when measles began to recede and persisted for two weeks or longer. The variation in time of appearance of the two types of liver disease may imply distinct pathogenetic mechanisms.