American Society for Gastrointestinal Endoscopy guidelines for appropriate use of colonoscopy: are they suitable for African patients?

This study investigates the appropriateness and diagnostic yield of colonoscopy referrals in an African setting using the American Society of Gastrointestinal Endoscopy guidelines: a prospective, descriptive, cross-sectional hospital-based study. A total of 311 patients were included in the study; 228 referrals (73.3%) were considered appropriate and clinically significant pathology was found in 157 patients, giving an overall diagnostic yield of 50.5%. Diagnostic yield in those with appropriate referrals was 58.8% and 27.7% (P = 0.004) in those with inappropriate referrals. In our setting these guidelines are useful in improving diagnostic yield and reducing the rate of inappropriate referrals for colonoscopy. However, patients above the age of 50 presenting with lower gastrointestinal symptoms should undergo a colonoscopy even if the indication was inappropriate, especially in countries which are not implementing colorectal cancer screening programmes for average risk patients.

Use of endoscopy in diagnosis and management of patients with dysphagia in an African setting.

The objectives of this study were to define the utility of esophagogastroduodenoscopy in the diagnosis and management of patients presenting with dysphagia and to determine the relative incidence of the various causes of dysphagia in Sudan. This is a prospective, cross-sectional, descriptive, hospital-based study carried out at the endoscopy unit of Soba University Hospital, Khartoum, Sudan. All patients complaining of dysphagia underwent upper gastrointestinal endoscopy with therapeutic intervention when necessary. A total of 114 patients were enrolled in the study, with a mean age of 47 years SD +/- 19 and a male to female ratio of 1 : 1.04. A benign condition was diagnosed in 56% of the cases; this included esophageal strictures in 21% of the cases and achalasia in 14%. Malignant causes were mainly due to esophageal cancer (40.4%) and cancer of the stomach cardia (3.5%). Therapeutic intervention was attempted in 83% of the cases. Risk factors predictive of a malignant etiology were age over 40 years (P < 0.000), dysphagia lasting between 1 month and 1 year (P < 0.000), and weight loss (P < 0.000). A barium study was performed in 35 cases (31%) prior to endoscopic examination and proved to be inaccurate in three cases (8.6%). Upper gastrointestinal endoscopy in our African setting is an accurate and useful investigation in the diagnosis and management of patients presenting with dysphagia. Patients over the age of 40 years presenting with dysphagia and weight loss are more likely to have a neoplastic disease and should be referred for urgent endoscopy.

Paediatric gastrointestinal endoscopy: experience in a Sudanese university hospital.

We investigated the indications for and findings of gastrointestinal (GI) endoscopy in all children < or = 16 years old referred for the procedure to the endoscopy unit at Soba University Hospital, Khartoum from January 2004 to January 2006. Thus 113 children were enrolled; 73% underwent upper GI endoscopy, 27% lower GI endoscopy (15% colonoscopy, 12% flexible sigmoidoscopy). Indications for upper GI endoscopy included haematemesis (24%), portal hypertension (21%), abdominal pain (16%) and vomiting (15%). Diagnoses included oesophageal varices (16%), gastritis (7%) and hiatus hernia (6%). Indications for lower GI endoscopy included rectal bleeding (87%), diarrhoea (19%) and anaemia (10%).

Paediatric gastrointestinal endoscopy: experience in a Sudanese university hospital

We investigated the indications for and findings of gastrointestinal [GI] endoscopy in all children </= 16 years old referred for the procedure to the endoscopy unit at Soba University Hospital, Khartoum from January 2004 to January 2006. Thus 113 children were enrolled; 73% underwent upper GI endoscopy, 27% lower GI endoscopy [15% colonoscopy, 12% flexible sigmoidoscopy]. Indications for upper GI endoscopy included haematemesis [24%], portal hypertension [21%], abdominal pain [16%] and vomiting [15%]. Diagnoses included oesophageal varices [16%], gastritis [7%] and hiatus hernia [6%]. Indications for lower GI endoscopy included rectal bleeding [87%], diarrhoea [19%] and anaemia [10%]

Gastrointestinal tract cancer in association with hepatitis and HIV infection.

One hundred and fifty patients with histologically proven gastrointestinal tract (GIT) cancer, 150 patients with a variety of other malignancies and 150 normal subjects were screened for human immunodeficiency virus (HIV) and hepatitis B sero-markers. Only one patient with nasopharyngeal carcinoma proved to be HIV seropositive. Hepatitis B surface antigen (HBsAg) was detected in 18% (n = 26) of the GIT cancer patients, in 16% (n = 24) of the other cancers group and in 12% (n = 20) of the control. There was no significant difference between the three groups (P > 0.1). The HBsAg was detected mainly in patients with primary hepatocellular (25%), gastric (12%), rectal (10%) and colonic carcinoma (8%). Hepatitis B core antibody (HBc AB) was detected in 12% of the GIT cancer patients, in 11% of the other cancers patients and in 13% of the control. In this study, there was no association between HIV, hepatitis B infections and GIT cancer.

PIP: 150 patients with histologically proven gastrointestinal tract (GIT) cancer, 150 patients with a variety of other malignancies and 150 normal subjects were screened for human immunodeficiency virus (HIV) and hepatitis B sero-markers. Only 1 patient with nasopharyngeal carcinoma proved to be HIV seropositive. Hepatitis B surface antigen (HBsAg) was detected in 18% (n = 26) of the GIT cancer patients, in 16% (n = 24) of the other cancer cases, and in 12% (n = 20) of the control group. There was no significant difference between the three groups (P 0.1). The HBsAg was detected mainly in patients with primary hepatocellular (25%), gastric (12%), rectal (10%), and colonic carcinoma (8%). Hepatitis B core antibody (HBcAB) was detected in 12% of the GIT cancer patients, in 11% of the other cancer patients, and in 13% of the control group. In this study, there was no association between HIV infection, hepatitis B infection, and GIT cancer.

Metronidazole prophylaxis in acute mural appendicitis: failure of a single intra-operative infusion to reduce wound infection.

The efficacy of a single 500 mg intravenous intra-operative dose of metronidazole in the prevention of postoperative wound infection, following appendicectomy for acute mural appendicitis, was studied in a prospective randomized placebo controlled trial. Fourteen of the 96 patients (14.6%) in the metronidazole group and 13 of the 94 in the placebo group (13.8%) developed postoperative wound infection. Late sepsis was noted in 4 out of the 96 patients in the metronidazole group and in one of the 94 patients in the placebo group. This study suggests that a single intra-operative dose of metronidazole dose not reduce the incidence of postoperative wound infection following appendicectomy for acute mural appendicitis.

Cimetidine does not reduce liver blood flow in cirrhosis.

Cimetidine has been shown to reduce liver blood flow, as measured by indocyanine green clearance, in normal subjects. Concern over the potential deleterious effects of such reduction in cirrhosis led to the measurement of blood flow in 14 cirrhotics receiving oral or intravenous cimetidine. Liver blood flow was measured by the clearance of galactose at steady state during infusion of 40 mg per min. In six patients receiving 300 mg cimetidine by mouth each 6 hr for 4 days, basal flow (1,019 +/- 186 ml per min) was not significantly altered by cimetidine (1,087 +/- 156 ml per min). Intravenous infusion of cimetidine (300 mg) did not significantly alter flow in five patients between the basal (1,096 +/- 334 ml per min) and treatment periods (1,051 +/- 383 ml per min). Hepatic extraction of galactose in three patients (82 +/- 19%) was not significantly altered by cimetidine infusion (81 +/- 13%). The failure to reduce liver blood flow with cimetidine in this population may be due to their diminished proportion of portal venous flow, or alternatively suggests that histamine is not an important modulator of flow via H2 receptors. At a clinical level, the use of cimetidine in this population can continue without fear of further reduction in liver blood flow.

Vascular malformations of the parotid region.

Five adult patients with vascular malformations in the parotid region are described. Three of these patients had lumps in the parotid gland clinically indistinguishable from parotid tumours: one had a diffuse swelling of the check, and the fifth had a pulsatile tumour in the deep lobe of the gland. Two patients had a characteristic sign-the lump in the cheek became more obvious, both visually and on palpation, when the masseter muscle was tensed. In 3 of the patients calcified opacities, resembling phleboliths, were demonstrated on plain X-ray examination. This is only the third report of vascular malformations of the parotid region in the British literature; no other report of a pulsating tumour within the parotid gland has been found in a search of the world literature.

Gallstone disease presenting as septicaemic shock.

Three patients are described who were admitted to hospital with septicaemic shock due to gallstones, but in none of whom had the presence of gallstones, been diagnosed previously. All 3 had positive blood cultures, Clostridium welchii being isolated in one patient (in another patient this organism was isolated from the bile). Two patients had renal failure requiring dialysis. All 3 patients survived. The management of this serious presentation of gallstones, hitherto poorly described in British literature, is discussed.

The efficacy of graduated compression stockings in the prevention of deep vein thrombosis.

The incidence of deep venous thrombosis (DVT) was studied by the 125I-fibrinogen technique in 70 patients who had had major abdominal operations and who were wearing graduated static compression stockings on one leg, the patient's other leg being used as a control. In the whole group 7 patients developed bilateral DVT, 19 patients developed unilateral DVT in the control leg and only one patient developed unilateral DVT in the stockinged leg. The difference between stockinged and control legs was highly significant (P = 0-0003). In the 19 patients with malignant disease the incidence of DVT in the stockinged leg remained significantly less (P = 0-037). It is concluded that graduated static compression stockings do reduce the incidence of postoperative deep venous thrombosis.