Esophageal stricture causes and pattern of presentation at Ibn Sina Specialized Hospital

Introduction: The aim of this study is to evaluate the causes and pattern of presentation of esophageal stricture in Ibn Sina Specialized Hospital. Methods:This is a retrospective study done at Ibn Sina Specialized Hospital during the period from April 2008 to December 2008. All patients had upper gastrointestinal endoscopy (UGIE), and those who were found to have esophageal stricture were enrolled in the study. The data collected were then processed and analyzed using appropriate statistical tests. Results and discussion: Out of 780 patients who had UGIE, 60 were found to have esophageal stricture; 37(61.6%) were males. The age group ranged between 20 years and 89 years, with a mean (± SD) age of 50.483 (±17.437) years. Esophageal cancer of the squamous cell carcinoma type (SCC) was the most important cause of stricture in the study. In both genders, the cancer was common in the elder age groups. Dysphagia was the commonest presenting symptom. Malignant and benign strictures were located at different site of the esophagus. In males postsclerotherapy was more common especially in the young, while peptic stricture was common in elderly. In females peptic stricture and esophageal webs were common in young adults (20 – 50 years). Endoscopic dilatation was performed successfully to 59 patients. Only one male in the age group 60 – 69 years was managed with percutaneous endoscopic gastrostomy (PEG) tube due to failure of dilatation. Conclusion: Esophageal stricture is an alarming sign of malignancy. Post-SCC stricture was detected in a considerable number of patients in our study group, therefore it require careful early diagnosis and distinction from other varieties because of their good outcome. Adenocarcinoma and other malignant tumors which cause esophageal stricture were not detected in our study group.Alcohol consumption was not a significant risk factor contributing to the development of post-SCC stricture in this study. Post-sclerotherapy stricture represented the peak in male farmers residing in the center of Sudan compared to females, other occupations and regions, and to other causes of benign stricture.Keywords: dysphagia, schistosmaisis, achalasia, adenocarcinoma, squamous

Non-infectious Complications of Peritoneal Dialysis among Sudanese Patients: Five Years Experience

Introduction: The technique of Continuous Ambulatory Peritoneal Dialysis (CAPD) is known to be associated with various infectious and non-infectious complications. The latter term includes anatomical/mechanical complications as well as hemoperitoneum, inflow pain, electrolyte disturbances, metabolic derangements and delayed gastric emptying. Methods: We retrospectively evaluated all patients who were maintained on CAPD for a minimum of 90 days in Sudan, in the period between May 2005 and Apr 2010. We examined the incidence of various non-infectious complications and their possible associations. Results: The analysis included 296 patients including 71 children (24%). Males constituted 62.2% of the study population and 13.9% were diabetic. The incidence per 100 patient-years of various non-infectious complications was as follows: hypokalemia (30.4), catheter dysfunction (10.8), dialysate leak (5.3), hernia (4.7), hemorrhagic effluent (4.7), inflow pain (2.3), upper gastrointestinal symptoms (2) and cuff extrusion (0.9). Catheter block and hernia were diagnosed with a median duration after catheter insertion of 6 and 7.5 months, respectively. Catheter block was significantly more prevalent among children (22.5% versus 9.3%; P = 0.006). A high body mass index (BMI) was the only identified independent predictor for leak (OR 1.4, P = 0.005). More than half of the 16 hernias were umbilical, and four of the five inguinal hernias were bilateral. Non-infectious complications were responsible for 32% of technique failures. Conclusion: Non-infectious complications were fairly common among our CAPD patients and led to catheter removal in a considerable number of patients. Care is, therefore, needed to screen CAPD patients for these complications in order to timely address and manage problems. Keywords: Peritoneal Dialysis; Non-infectious Complications; Sudan; Herni