Outcome of cholecystectomy in diabetic patients

BACKGROUND : Mortality and morbidity from gallstones in the diabetic patients in comparison with the nondiabetics are always controversial. AIMS : To evaluate the risk factors associated with morbidity from gallstones. MATERIALS AND METHODS : We have analyzed data from 669 cholecystectomies performed between March 2002 and December 2003. RESULT S: Among 669 patients, 116 had complications. Complications included 68 adhesions, 26 gangrenes of the gallbladder, 14 pancreatitis, 20 hydropses, and 5 perforations. In univariate analysis, age, diabetes, hypertension, and ischemic heart disease were significantly associated with high risk of complications. In multivariate analysis, only diabetes caused a significant increase in complications with odds ratio (OR) of 6.1 [95% Confidence Interval (CI): 3.8-9.9]. Diabetes was also significantly associated with high risk of adhesion (OR = 5.9; 95% CI: 3.3-10.5), gangrene (OR = 7.6; 95% CI: 3.1-18.5) and pancreatitis (OR = 4.5; 95% CI: 1.3-15.8). CONCLUSION: Although this study does not directly support prophylactic cholecystectomy, the increased morbidity in the diabetics implies that diabetic patients with asymptomatic gallstone need more care and attention

The indirect role of site distribution in high-grade dysplasia in adenomatous colorectal polyps

Background: The appropriate application of Endoscopic modalities for polypectomy depends on the likelihood that the adenoma in question harbors invasive cancer. While prior studies have evaluated polyp size and morphology in assessing the risk of malignancy, in recent decay some authorities have paid more attention to dysplasia. All in all, the relative risk of cancer based on polyp distribution in correlation with dysplasia has not been statistically studied which is done in our study. Methods and Materials: Between June 2001 and March 2004, the distribution of 130 adenomatous polyps was compared with synchronous invasive or in situ cancer. Factors such as Patient age, Patients gender, location of lesion, size of polyp, histological subtype of adenoma on biopsy, degree of dysplasia, synchronous cancer, color of polyp, and number of polyps were included in the data collection. Results: Multivariate logistic regression test was used to evaluate the association between malignancy and various clinical variables. It revealed histological subtype, high grade of dysplasia and size to be independent predictor of malignancy. However; left-sided location and histological subtype to be independent risk factor for high-grade dysplasia. Conclusion: Lesions greater than 1 cm in diameter with high-grade dysplasia after speleinc flexure should be managed as presumptive malignancies with segmental colon resection. In intermediate-risk lesions the physician should decide individually

The puzzle of self-reported weight gain in a month of fasting (Ramadan) among a cohort of Saudi families in Jeddah, Western Saudi Arabia

<p>Abstract</p> <p>Background</p> <p>During Ramadan fast, approximately one billion Muslims abstain from food and fluid between the hours of sunrise to sunset, and usually eat a large meal after sunset and another meal before sunrise. Many studies reported good health-related outcomes of fasting including weight loss. The objective of this study is to identify the local pattern of expenditure on food consumption, dietary habits during Ramadan and correlate that to self-reported weight gain after Ramadan in a group of families in Jeddah, Western Saudi Arabia.</p> <p>Methods</p> <p>A Cross-section study using a pre-designed questionnaire to identify the local pattern of expenditure on food consumption, dietary habits during Ramadan and correlate that to self-reported weight gain after Ramadan in a representative cohort of Saudis living in Jeddah. It was piloted on 173 nutrition students and administered by them to their families.</p> <p>Results</p> <p>A total of 173 Saudi families were interviewed. One out of 5 indicated that their expenditure increases during Ramadan. Approximately two thirds of the respondents (59.5%) reported weight gain after Ramadan. When asked about their perspective explanations for that: 40% attributed that to types of foods being rich in fat and carbohydrates particularly date in (Sunset meal) 97.7% and rice in (Dawn meal) 80.9%. One third (31.2%) indicated that it was due to relative lack of physical exercise in Ramadan and 14.5% referred that to increase in food consumption. Two thirds (65.2%) of those with increased expenditure reported weight gain.</p> <p>Conclusion</p> <p>Surprisingly weight gain and not weight loss was reported after Ramadan by Saudis which indicates timely needed life-style and dietary modification programs for a population which reports one of the highest prevalence rates of diabetes.</p

Safety of early oral feeding after gastrointestinal anastomosis: a randomized clinical trial

Background: Different abdominal surgeries could benefit from early feeding. Aims: To compare early feeding with traditional postoperative dietary management for development of postoperative gastrointestinal (GI) symptoms. Settings and Design: A prospective randomized controlled study. Methods and Materials: This was a study of 110 patients who were randomly allocated to early feeding beginning with liquid diet, 8 h postoperatively; whereas those in the traditional feeding group were given a regular diet with normal bowel sounds Statistical analysis used: Fisher exact test, P value less than 0.05 was significant. Results: There were no differences in patients\u2032 demographics, surgical procedure, and anesthesia used. Complete data were available for 110 patients; 55 were allocated to the early feeding group and 55 to the late feeding group. The incidence of postoperative ileus did not differ between the two groups [early 1 (1%) vs late (1) 1%, P &gt; 0.05 NS]. However, there was no significant difference in the rate of intraoperative complication such as, leakage of anastomosis, mesenteric embolus, wound infection, and wound dehiscence between groups [7.2% (4) vs 16.36% (9), respectively, P value = 0.093 NS]. Also, there were no significant differences in mortality between the two groups. Conclusion: Early feeding in GI anastomosis seems to be safe, well tolerated, and was not associated with increased postoperative GI complaints including ileus and postoperative complications such as wound dehiscence, infection, leakage, anastomosis, and mortalit

Adopting Ultrasound Guidance for Prone Percutaneous Nephrolithotomy: Evaluating the Learning Curve for the Experienced Surgeon

Objectives: To define the learning curve associated with adopting ultrasound guidance for prone percutaneous nephrolithotomy (PCNL) for the experienced surgeon. Methods: A prospective cohort study of consecutive patients undergoing PCNL with ultrasound guidance for renal tract access and dilation was performed. Clinical data reviewed included success in gaining renal access with ultrasound guidance, total fluoroscopic screening time, and radiation exposure dose. PCNL cases performed with fluoroscopic guidance matched for stone size served as control cases. Results: One hundred consecutive ultrasound-guided procedures performed by a single experienced endourologist were divided into five experience groups. Significant improvement in renal access success rate with ultrasound was seen after 20 cases (p < 0.05). Total fluoroscopic screening time, radiation exposure dose, and operative time were also statistically significantly improved over the study period. When compared with fluoroscopy-guided PCNL, significant decreases in total fluoroscopic screening time (33.4 ± 35.3 seconds vs 157.5 ± 84.9 seconds, p < 0.05) and radiation exposure (7.0 ± 8.7 mGy vs 47.8 ± 45.9 mGy, p < 0.05) were seen. No differences in complication rates were found. Conclusions: Ultrasound-guided renal access for PCNL can be performed effectively after 20 cases. Transition to the use of ultrasound will quickly reduce radiation exposure for patients and intraoperative personnel