Different surgical modalities in management of paediatric abdominal lymphoma.

BACKGROUND: The abdomen is one of the most frequent sites for lymphoma in children. The role of surgery has been limited to intra-abdominal resectable tumours or as a diagnostic procedure in case of disseminated disease. Laparotomy without total excision of the tumour does not improve survival; moreover, it may cause complications and delays initiation of chemotherapy. AIM OF THE WORK: This study was undertaken to assess the role of surgery in the management of children and adolescents presenting with intra-abdominal lymphoma in order to create certain criteria to select the proper surgical modality for managing those patients. PATIENTS AND METHODS: This case-series, retrospective study was done on 33 patients of abdominal lymphoma over a period of seven years from 2000 to 2007. Patients' files were reviewed regarding the full clinical examinations, laboratory and radiological investigations as well as surgical and diagnostic procedures. Collected data were tabulated and statistically analyzed using SPSS program package. RESULTS: Eleven patients (33.3%) presented with huge pelvi-abdominal mass and eleven (33.3%) had generalized lymphadenopathy beside their abdominal affection. The remaining 11 (33.3%) patients presented with symptoms of an acute abdomen. A total of 15 laparotomies were done. 11 patients underwent emergency laparotomy for acute abdomen and 4 patients had elective abdominal exploration. Lymph node biopsies were taken in 7 patients and laparoscopy procedures were performed in 3 patients as a diagnostic tool. Out of the total 33, the remaining 8 patients underwent true cut needle biopsy for diagnosis of their disease. CONCLUSION: Surgery still has a role in treatment of lymphoma whether non Hodgkin or Hodgkin's. However, in disseminated metastatic disease, aggressive debulking of the tumour should be avoided as chemotherapy is to be instituted primarily. Surgical resection does not cause significant change in morbidity or mortality. KEYWORDS: Abdominal lymphoma in paediatrics, role of surgery.

Predictors of fetal demise after trauma in pregnant Saudi Arabian women.

In Saudi Arabia, road traffic crashes are becoming a serious public health problem and there are no recent, large-scale, published reports discussing maternal and fetal injuries. We aimed to explore the predictors of fetal death/abortion after maternal trauma. A retrospective case-control study was performed exploring cases of maternal trauma. The study group included 118 women with pregnancy loss while 308 women without loss represented the control group. All data were compared using univariate analysis followed by multivariate regression analysis. Only 3 predictors were associated with significant effect on pregnancy loss after trauma (P < 0.05): second trimester of pregnancy (OR 2.77, 95% CI: 1.66-4.63, placental abruption (OR 3.69, 95% CI 2.01-6.79) and severe injury score (OR 6.78, 95% CI: 4.04-11.37).

HLA class II DRB1 resistance and susceptible markers in hydatidosis Saudi patients in association to the clinical course and gender.

Hydatidosis constitutes a major public health problem in kingdom of Saudi Arabia. The variability on susceptibility to hydatidosis has been related to the HLA system. So this study aimed to identifying the possible association between the class-II HLA-DRB1 alleles with the occurrence of hydatidosis and the clinical course in Saudi patients using Micro SSP HLA-DRB1 kits. Since HLA-disease associations might vary in relation to gender, so this study aims also to determining the HLA-DRB1 alleles- hydatidosis association in relation to gender. The results proved that HLA-DR16 and HLA-DR7 alleles were the suitable markers of susceptibility association while HLA-DR1 and HLA-DR10 alleles might confer protection against hydatidosis. All the previous susceptible and resistance associations were statistically significant. Also, the majority of the female patients (81.8%) had HLA-DR14 compared to 9.1% of female controls while 50% of the male patients had HLA-DR7 compared to 4.5% of male controls. These results were statistically associated and this is the first study that found an association between certain HLA-DRB 1 alleles and the occurrence of human hydatidosis in relation to gender. Also, significant relations were detected between HLA-DR16 and hepatic and single cyst, HLA-DR7 and lung cyst, HLA-DR14 and combined cysts. Also, no statistical significance was found between other cystic characteristics and any one of the susceptible HLA-DRBs. On conclusion beside the role HLA-DRB 1 on the susceptibility or the resistance to hydatidosis disease occurrence among Saudi population also it may have an important role in the prevalence of the disease in relation to gender.

Predictors of fetal demise after traume in pregnant Saudi Arabian women

In Saudi Arabia, road traffic crashes are becoming a serious public health problem and there are no recent, large-scale, published reports discussing maternal and fetal injuries. We aimed to explore the predictors of fetal death/abortion after maternal trauma. A retrospective case-control study was performed exploring cases of maternal trauma. The study group included 118 women with pregnancy loss while 308 women without loss represented the control group. All data were compared using univariate analysis followed by multivariate regression analysis. Only 3 predictors were associated with significant effect on pregnancy loss after trauma [P < 0.05]: second trimester of pregnancy [OR 2.77, 95% CI: 1.66-4.63, placental abruption [OR 3.69, 95% Cl: 2.01-6.79] and severe injury score [OR 6.78, 95% Cl: 4.04-11.37]

Non-operative management of blunt hepatic injury in multiply injured adult patients.

BACKGROUND: Non-operative management of blunt liver trauma has now evolved into a common practice especially since abdominal CT has enabled a more precise evaluation of these patients. CLINICAL MATERIAL: Sixty-three patients, haemodynamically stable, were eligible for the study and enrolled into the protocol of non-operative management of blunt hepatic injury. Fifty-two (82.5%) patients were successfully managed non-operatively (non-operative group). The remaining 11 (17.5%) patients failed the non-operative management and underwent exploratory laparotomy (laparotomy group). RESULTS: Patients managed non-operatively tended to be younger than patients managed operatively (p < 0.05). The mean values of ISS were 16.2 +/- 6.1, 26.1 +/- 8.5, p < 0.001, in the non-operative and laparotomy groups, respectively. Stay in the ICU was significantly decreased in the non-operative patients (p < 0.001). Patients who had a laparotomy significantly increased requirement for blood transfusion (p < 0.001). Six (9.5%) patients managed non-operatively developed complications; perihepatic collections were observed in two patients, an urinoma in one patient and chest infection in three patients. Perihepatic collections and urinoma were successfully drained percutaneously by CT guidance and no further treatment was required. The mortality rate of the entire series of patients was 4.8% (three patients); one death could be related to hepatic injury itself and the other two deaths were attributed to non-hepatic causes. No deaths occurred in the non-operative group. CONCLUSION: Non-operative management should be the initial approach to all patients with blunt liver injuries if haemodynamic stability can be ensured. When continued bleeding can be safely ruled out, a period of close monitoring in the ICU is warranted.