Life event stress in duodenal ulcer compared with functional dyspepsia: a case-control study

This is a prospective study of life event stress in 80 duodenal ulcer patients compared with 80 patients with functional dyspepsia and 80 healthy controls; matched for age, sex and marital status. A semi structured psychiatric interview was used in the psychiatric assessment of the dyspeptic patients and controls. A modified version of Life Events Scale by Tennant and Andrews was used in the assessment of life event stress. More dyspeptic patients reported life events than the controls, but, on the whole, the differences were not statistically significant. On the other hand, more patients with functional dyspepsia experienced life events than the patients with duodenal ulcer, but again the results were not consistent. Life event stress as measured by the experience of undesirable life events was significantly reported by more patients with functional dyspepsia. The significance of the presence of life events in duodenal ulcer and functional dyspepsia patients is not substantiated in the present study, as the positive findings were few and sometimes inconsistent. More quantitative studies are needed, taking into consideration the other aspects of the problem like personality, cognition and the complex interaction of stressors and personality.

Diagnostic and therapeutic value of ERCP and prediction of outcome: a retrospective analysis

The objective is to analyze the experience of using diagnostic and therapeutic ERCP and to attempt identifying the independent factors that predict positive and useful procedures. The medical records of 198 patients seen during the period 1991-1993 were retrospectively reviewed. There were 102 males and 96 females with a mean age of 45.2 SD + 16.7 years. The main indications for performing the procedure were jaundice, abdominal pain, nausea and/or fever. Laboratory tests showed elevated direct bilirubin in 50% of patients, deranged liver enzymes in 43%, and ESR was raised in 51% and fever was documented in 52% of patients. The cannulation of both ducts was successful in 93% of all procedures. The commonest finding was gallbladder and common bile duct stones (CBD). In 54 patients out of 64 with CBD stones, stones were removed endoscopically. Stepwise regressive analyzis has identified age above 40 years, presence of jaundice (total bilirubin > 2.5 mg/ml) and raised ESR (> 25 mm in the 1st hour) as significant factors that independently predict a positive ERCP that revealed findings previously unknown (useful procedure). Diagnostic and therapeutic ERCP is an integral part in management of biliary and pancreatic ducts disorders. The validity of clinical prediction role should be tested prospectively.

Pattern of pediatric upper gastrointestinal disease: a teaching hospital experience

During the period 1983-1993, 166 pediatric patients(91 females and 75 males) were subjected to upper gastrointestinal endoscopy. Epigastric pain or heart burn and vomiting were the indications in 115 (69%) patients. Gastritis. duodenitis, and esophagitis were diagnosed in 63 (38%), and duodenal ulcer in seven (4.2%) patients. Bleeding sites were identified in 10 out of 21 (47.6%) patients with a history of hematemesis. Helicobacter pylori was identified in 12 (48%) of 25 patients with chronic gastritis. Endoscopic removal of foreign bodies (FB) was required in nine patients. Endoscopic small bowel biopsy provided sufficient material to con-firm the diagnosis in seven out of 13 patients with chronic diarrhea. Endoscopic findings were normal in 78 (47%) patients. The procedure was safe and well tolerated.

Appendicular schistosomiasis: a cause of clinical acute appendicitis?

The role of schistosomes in the pathologenesis of acute appendicitis in an endemic area was investigated. Of 1600 appendicectomies received in our laboratory, 26 showed appendiceal schistosomiasis, which prompted what we believe to be the first detailed histopathological evaluation of all appendices with schistosomal infestation, without prior knowledge of the clinical and operative diagnoses. The results suggest that there are two types of schistosomal appendicitis, each with distinct clinicopathological features and different pathogenetic mechanisms. They could be called obstructive and granulomatous schistosomal acute appendicitis, respectively.

Oral cancer in Saudi Arabia: the role of alqat and alshammah

The purpose of this retrospective clinical study is to look into the etiological role of alshammah and alqat consumption in the causation of squamous cell carcinoma of the head and neck (SCHN) in Arabia. Alshammah and alqat are traditional forms of chewable tobacco very commonly used in southern Saudi Arabia and Yemem. In a 2 year period 64 patients with histologically proven SCHN were found. Most of them were originally from southern Saudi Arabia and Yemen. Of these 64 patients 52 (81%) admitted alshammah consumption. Of these 52 patients 22 admitted alqat consumption in addition. Thirty-eight (59%) had oral cancer, while the rest had pharyngeal and laryngeal cancer. All the 38 patients with oral cancer either used alshammah alone (16 patients) or used both alshammah and alqat (22 patients). The median duration of alshammah consumption was 15 years and that of alqat was 12 years. Alcohol was not consumed among the group and only few were cigarette smokers. Most patients presented in the late stage of the disease. The evidence implicating alshammah and alqat in the causation of SCHN is only clinically based. Further controlled prospective clinical and experimental studies are needed to confirm the theory.