Is Bowel Rest a Prerequisite for Successful Outcome in Nonoperative Management of Extrahepatic Bile Duct Blunt Injury in Children?

Extrahepatic bile duct injury resulting from blunt abdominal trauma in children is not common. Nonoperative management has become the standard of care. During a two-year period from January 2005 to December 2006, we treated 1015 pediatric traumas. Of those, 103 were blunt abdominal trauma. Only two patients had injury to the extrahepatic bile ducts. Both cases were managed nonoperatively; however, the clinical presentation required a different approach. Facilitation of bile flow by means of sphincterotomy, or putting a transampullary stent, had the most significant impact on successful outcome. Bowel rest did not influence outcome. Therefore nonoperative management of blunt extrahepatic bile duct blunt injuries in children should be based on ensuring adequate bile flow. Bowel rest does not seem to be a prerequisite for successful outcome.Index Word: Blunt abdominal trauma; extrahepatic bile duct injury; nonoperative

Collaborative Filtering Based Recommendation System: A survey

Abstract—the most common technique used for recommendations is collaborative filtering. Recommender systems based on collaborative filtering predict user preferences for products or services by learning past user-item relationships from a group of user who share the same preferences and taste. In this paper we have explored various aspects of collaborative filtering recommendation system. We have categorized collaborative filtering recommendation system and shown how the similarity is computed. The desired criteria for selection of data set are also listed. The measures used for evaluating the performance of collaborative filtering recommendation system are discussed along with the challenges faced by the recommendation system. Types of rating that can be collected from the user to rate items are also discussed along with the uses of collaborative filtering recommendation system

A minimally invasive option for the treatment of persistent postoperative esophageal leak

Persistent postoperative leaks in esophageal surgery in children are highly morbid. They usually require technically difficult major reoperations. A less invasive approach is always desirable. During the period 2003 to 2007, we used a minimally invasive approach for the treatment of persistent postoperative esophageal leaks in two children by injection of fibrin glue into the leak site through a small catheter that was introduced through the chest tube. The procedure was successful in one case. We introduce this approach as an alternative to surgery. We found it to be a safe and viable option for the treatment of persistent postoperative esophageal leaks.Keywords: chest tube, esophageal leak, fibrin glu

A valid treatment option for isolated congenital microgastria

Congenital microgastria (CM) is an extremely rare anomaly of the caudal part of the foregut. Treatment of CM has not yet been standardized. We present the case of a 34-monthold girl with an isolated CM complicated by nasogastric tube-related gastric perforation. During the definitive reconstructive surgery, a scarred structure (1.5 1.5 cm) was found to follow a dilated esophagus. The scarred microstomach was resected, and a Roux-en-Y esophagojejunostomy was performed. The patient has been followed for 6 months. She tolerates a regular oral diet and has reached acceptable growth parameters. We describe the first case of CM to be treated with resection of the microstomach and with a Roux-en-Y esophagojejunostomy.Keywords: congenital microgastria, gastrectomy, Roux-en-Y esophagojejunostom

Bacillus Calmette-Guérin-related cold thigh abscess as an unusual cause of thigh swelling in infants following BCG vaccine administration: a case series

<p>Abstract</p> <p>Introduction</p> <p>Thigh swelling in an infant can be a symptom of a simple benign condition or a life-threatening condition. We observed a cluster of thigh swelling episodes in infants in which the cause was Bacillus Calmette-Guérin-related cold thigh abscess. We report this unusual case series to raise awareness about this diagnosis.</p> <p>Case presentations</p> <p>We performed a retrospective review of five infants (four boys and one girl) who presented with Bacillus Calmette-Guérin-related left thigh abscess. The swelling was noticed by the parents at a mean period of three months prior to presentation. The ages at presentation were five, five, eight and nine months for the boys, and six months for the girl. All of the patients were healthy Saudi infants, and received the Bacillus Calmette-Guérin vaccine at birth. Clinically, all of the patients were well and did not demonstrate signs of systemic infection. All patients underwent needle aspiration, with subsequent incision and drainage in four of the five cases. The cultures obtained from the abscess fluids were the key to establishing the diagnosis. Only three patients (60%) received antituberculosis drugs. Wound healing lasted for a mean period of approximately seven months. Two-year follow-up was unremarkable for all of our patients.</p> <p>Conclusions</p> <p>Technical errors continue to be significant in the development of vaccine-related complications. Bacillus Calmette-Guérin-related cold thigh abscess is an extremely rare entity.</p

Gravity Probe B: Final Results of a Space Experiment to Test General Relativity

Gravity Probe B, launched 20 April 2004, is a space experiment testing two fundamental predictions of Einstein's theory of General Relativity (GR), the geodetic and frame-dragging effects, by means of cryogenic gyroscopes in Earth orbit. Data collection started 28 August 2004 and ended 14 August 2005. Analysis of the data from all four gyroscopes results in a geodetic drift rate of -6,601.8+/- 18.3 mas/yr and a frame-dragging drift rate of -37.2 +/- 7.2 mas/yr, to be compared with the GR predictions of -6,606.1 mas/yr and -39.2 mas/yr, respectively (`mas' is milliarc-second; 1mas = 4.848 x 10-9 rad)

Endophthalmitis associated with the Ahmed glaucoma valve implant

Aim: To investigate the rate, risk factors, clinical course, and treatment outcomes of endophthalmitis following glaucoma drainage implant (GDI) surgery. Methods: A computerised relational database search was conducted to identify all patients who were implanted with Ahmed glaucoma valve (AGV) and developed endophthalmitis following surgery at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, between 1 January 1994 and 30 November 2003. Only medical records of the patients who developed endophthalmitis were retrospectively reviewed. Results: 542 eyes of 505 patients who were on active follow up were included in the study. Endophthalmitis developed in nine (1.7%) eyes; the rate was five times higher in children than in adults. Delayed endophthalmitis (developed 6 weeks after surgery) occurred in eight of nine eyes. Conjunctival erosion overlying the AGV tube was present in six of nine eyes. Common organisms isolated in the vitreous included Haemophilus influenzae and Streptococcus species. Multiple regression analysis revealed that younger age and conjunctival erosion over the tube were significant risk factors associated with endophthalmitis. Conclusion: Endophthalmitis is a rare complication of GDI surgery that appears to be more common in children. Conjunctival dehiscence over the GDI tube seems to represent a major risk factor for endophthalmitis. Prompt surgical revision of an exposed GDI tube is highly recommended

Primary and secondary congenital glaucoma: baseline features from a registry at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

To compare the demographic and clinical distribution of primary and secondary congenital glaucoma from a registry at King Khaled Eye Specialist Hospital. Registry-based cohort study. Review of registry data that included new patients with congenital glaucoma seen between 2001 and 2003 (29 months); analysis of the demographic data and clinical features of primary and secondary congenital glaucoma at presentation. A total of 325 eyes of 180 patients were included. Most patients had primary congenital glaucoma (80%). The mean (± SD) age at presentation for primary congenital glaucoma was 3.8 ± 10.7 months and for secondary congenital glaucoma was 4.3 ± 7.9 months. Most primary congenital glaucoma and secondary congenital glaucoma patients had bilateral disease (82.6%; 74.3%). Primary congenital glaucoma was equally distributed by sex but secondary congenital glaucoma was 1.5-fold more common in male patients. A positive family history was elicited in 30%, and almost 60% had a history of consanguinity in both groups. The mean intraocular pressure and corneal diameter were comparable in both groups but the axial length was significantly longer in primary congenital glaucoma and cup-to-disc (C/D) ratio greater in secondary congenital glaucoma. In the primary congenital glaucoma group, corneal haze showed a significant relationship with most clinical parameters. In primary congenital glaucoma, a positive correlation was noted between age at presentation and increasing corneal diameter and axial length but a negative relationship was noted with C/D ratio and corneal haze, whereas for secondary congenital glaucoma only axial length was positively correlated. The congenital glaucoma registry provides unique baseline data on primary congenital glaucoma and secondary congenital glaucoma in Saudi Arabia that will enable us to better understand the disease in the Kingdom and region. Copyright © 2013 Elsevier Inc. All rights reserved