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2003| September-December | Volume 9 | Issue 3
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Management of complicated gallstone disease during pregnancy
Mohammed Hamad Al-Akeely
September-December 2003, 9(3):135-138
Controversy still exists regarding the optimal management of complicated gallstones during pregnancy owing to the possible risks for the fetus. Generally the management of such problems during pregnancy is conservative, however, endoscopic retrograde cholangiopancreatography (ERCP) and/or operative intervention may be required in some patients.
Aim of study:
The aim is to evaluate the management of complicated gallstone disease with particular reference to the indications, timing and risks of ERCP and operative intervention during pregnancy and its effect on fetus outcome.
Patients and methods:
This retrospective study was conducted on 32 pregnant women, who were admitted with complication of cholelithiasis at Riyadh Medical Complex (RMC) through the emergency during the period of March 1998-October 2002. Their files were evaluated for age, presentation, gestational age, hematological, radiological, fetus assessment, management, fetus out come and how ERCP and surgery were performed.
Among the 32 pregnant women studied, 22 responded satisfactorily to conservative treatment. They had laparoscopic cholecystectomy (LC) after delivery. Ten patients needed further treatment, two were operated for acute cholecystitis (AC) and recurrent biliary colic (BC). Eight patients had ERCP for obstructive jaundice and recurrent pancreatitis following which two had LC cholecystectomy. All patients remained well until delivery. Conclusion: Majority of gallstone complications during pregnancy can be managed conservatively. Surgery can be deferred until delivery. Few patients who needed ERCP and/or surgery can be managed safely during second and third trimester
Honey potentiates the gastric protection effects of sucralfate against ammonia-induced gastric lesions in rats
Abu Taib Mohammad Mobarok Ali, Othman Abdullah Al Swayeh
September-December 2003, 9(3):117-123
Natural honey is widely used all over the world as a complementary and alternative medicine in various disorders including gastrointestinal lesions.
To evaluate the effects of combination of low dosage of honey (0.312g/kg) and sucralfate (0.125 or 0.250 g /kg) on gastric protection and to determine any potentiating interactions between them against ammonia-induced gastric lesions in rats.
Material and Methods:
Twenty-four hours fasted rats were given I ml of ammonium hydroxide 1 % intragastrically and they were killed one hour later under deep ether anesthesia. The gastric lesion index was calculated according to the method of Takaishi et al 1998. Non protein sulthydryls level was determined spectrophotometrically as described by Sedlak and Lindsay 1968. Results: Administration of ammonium hydroxide produced red and black linear lesions and significant depletion of gastric nonprotein sulthydryls level. Oral administration of honey (0.312g/kg) or sucralfate (0.125 and 0.250g/kg) 30min before ammonium hydroxide reduced the severity of gastric mucosal lesions by 1 I or 18 and 42 % respectively, and has shown the changes in nonprotein sulfhydryls level induced by ammonium hydroxide. Furthermore, pretreatment with a combination of a low dose of honey (0.312g /kg) and sucralfate (0.125g or 0.250g/kg) afforded significantly greater protection (58 and 77 %) than that obtained with either of them administered alone.
The present results suggest potentiation of gastric protection effect of sucralfate by honey and this may have a clinical value in the treatment of peptic ulcer diseases in
Laparoscopic cholecystectomy: The outcome with minimal conversion rate: Experience in a district hospital
Abdulhameed Safar Al Ghamdi, Hussein Sami Khamis, Rida El Shawatfy El Said, Gamal Ahmed Khairy
September-December 2003, 9(3):124-128
Background: Since introducing laparoscopic cholecystectomy (LC) different centres have reported different conversion rate (CR) to open cholecystectomy (OC) and different reasons for conversion.
To evaluate the role of LC in the treatment of symptomatic gallstones and establish the outcomes of this treatment modality in general, looking especially into the rate of conversion to OC, at a district hospital.
Patients and methods:
From July 1992-July 1998, 751 patients who underwent LC were retrospectively reviewed. All patients with symptomatic gallstones were offered LC with no exclusion criteria apart from anaesthetic opinion. No attempts were made at selection of patients for LC.
There were 751 patients with symptomatic gallstones (617 females, 134 males) underwent LC. Chronic cholecystitis represented the majority of cases (83%). The mean operative time was 65.52 minutes: pre-operation and main hospital stay was 2.46 days. Our total conversion rate was 0.9% and 0.4% if malignancy of the gallbladder is excluded. In comparison to the published data, there was obvious lower conversion rate, which was neither associated with increased morbidity nor mortality.
Laparoscopic cholecystectomy is a reliable, safe and cost effective treatment modality for symptomatic gallstones. With growing experience in laparoscopic technique, proper settings and harmony of the operating team, it is possible to bring the conversion rate to OC to the minimum without any increment in mortality or morbidity
Undifferentiated (embryonal) sarcoma of the liver: Case report and review of the literature
Manochehr Aghajanzadeh, Hedayat Riazi, Mohammad Reza Kohsari, Maryam Jafroodi, Saba Hoda, Mohammad Najafi Ashtiani
September-December 2003, 9(3):139-141
Caecal lipoma causing colo-colonic intussusception
Omer Yousif El Tinay, Iftikhar Ahmed Rasheed Khan, Osman Hassan Noureldin, Ahmed Amer Al Boukai
September-December 2003, 9(3):145-147
Interferon-ribavirin therapy for chronic hepatitis C: Efficacy in Saudi patients
Abdulkareem Mohammad Sandokji, Faisal Mohammed Sanai, Abdulaziz Abdullah Al-Ajlan, Mohammed Ali Al-Karawi
September-December 2003, 9(3):129-134
Hepatitis C affects 2% of Saudi population. Previous local trials showed low response to interferon monotherapy for six-months.
To evaluate biochemical and virological response of interferon-ribavirin combination on naive Saudi patients infected with HCV.
A prospective single armed study was conducted at Riyadh Armed Forces Hospital from July 1999 to July 2002 for fifty patients who have hepatitis C virus (HCV-PCR) positive and chronic hepatitis on liver biopsy were started on the combination therapy for oneyear. All had HCV-PCR at the end of therapy and at six months follow-up.
Thirty-one patients (62%) normalized their ALT levels, and 25 patients (50%) became HCV-PCR negative achieving end-of-treatment response (ETR). The sustained virological response (SR) was achieved in 19 patients (38%) at six months follow-up after stopping the treatment. Side effects were mainly flu like syndrome in 36 patients (72%).
Combination therapy of interferon alfa-2b plus ribavirin is an effective treatment modality for HCV infected Saudi patients, with tolerable side effects. Our virological response rates are compatible with international published literatures
Hepatocellular carcinoma and gall bladder adenocarcinoma: Two primaries with no significant risk factors
Ahlam Abdullah Al-Shedoukhy, Ayed Abdullah Al-Garni
September-December 2003, 9(3):142-144
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