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2.  Hepaticocholecystoduodenostomy compared with Roux-en-y choledochojejunostomy for decompression of the biliary tract 
Annals of Saudi Medicine  2009;29(5):383-387.
BACKGROUND AND OBJECTIVES:
The nature of palliative decompressive surgery for unresectable periampullary tumor is usually determined by the experience of the surgeon. We compared hepaticocholecystoduodenostomy (HCD), a new palliative decompressive anastomotic technique, to Roux-en-y choledochojejunostomy (CDJ) in this prospective, randomized study.
PATIENTS AND METHODS:
Twenty patients who were to undergo surgery for palliative bypass were randomized into two groups: group I was subjected to HCD (10 patients) and group II to CDJ (10 patients). Pre- and postoperative liver function tests, operative time, operative blood loss, onset of postoperative enteral feeding, length of hospital stay and survival rates were compared in the two groups.
RESULTS:
Effective surgical decompression was observed clinically as well as on analysis of pre- and postoperative liver function tests in both the groups. The results were statistically significant in favor of patients in group I when compared to those of group II with respect to operative time 84.7 (10.3) min vs 133.6 (8.9) min; P =<.0001), operative blood loss 137.8 (37.2) mL vs 201.6 (23.4) mL; P =.001), postoperative enteral feeding 3.3 (0.5) days vs 5.0 (0.7) days; P=<.0001) and length of hospital stay 7.5 (0.7) days vs 9.7 (1.2) days; P=<.0001). During follow-up, recurrent jaundice was observed in one patient in group I and two patients in group II, while duodenal obstruction developed in one patient in the group I series. Gastrointestinal hemorrhage occurred in one patient belonging to group II. The difference in mean survival time was not statistically significant.
CONCLUSION:
Based on this small series, HCD seems to be a better palliative surgical procedure than the routinely performed CDJ.
doi:10.4103/0256-4947.55169
PMCID: PMC3290042  PMID: 19700897
3.  Filariasis of the breast, diagnosed by fine needle aspiration cytology 
Annals of Saudi Medicine  2009;29(5):414-415.
doi:10.4103/0256-4947.55178
PMCID: PMC3290043  PMID: 19700906
4.  Vitamin D levels in healthy men in eastern Saudi Arabia 
Annals of Saudi Medicine  2009;29(5):378-382.
BACKGROUND
Studies in 1980s and 1990s indicated that vitamin D levels in the ethnic Saudi Arabian population were low but no studies since that time have evaluated vitamin D levels among healthy young or middle-aged Saudi men. Thus, we assessed the serum level of 25-hydroxyvitamin D (25OHD) among healthy Saudi Arabian men living in the Eastern Province.
SUBJECTS AND METHODS:
One hundred males aged 25-35 years (the age range of peak bone mass) and 100 males aged 50 years or older were randomly selected and evaluated clinically, including measurement of serum calcium, parathyroid hormone (PTH) and serum 25OHD levels. Vitamin D deficiency was defined as a serum level of 25OHD of ≤20 ng/mL and insufficiency as a serum level between >20 ng/mL and <30 ng/mL and normal ≥30 ng/mL.
RESULTS:
The mean (SD) age of subjects in the younger age group was 28.2 (4.5) years. Twenty-eight (28%) had low 25OHD levels; 10 (10%) subjects were vitamin D deficient with a mean level of 16.6 (3.4) ng/mL and 18 (18%) were vitamin D insufficient with a mean level of 25.4 (2.7) ng/mL. In the older age group, the mean age was 59.4 (15.6) years and 37 (37%) had low 25OHD; 12 (12%) subjects were deficient with a mean 25OHD level of 16.7 (3.4) ng/mL and 25 (25%) were insufficient with a mean 25OHD level of 25.3 (3.3) ng/mL.
CONCLUSION:
The prevalence of vitamin D deficiency among healthy Saudi men is between 28% to 37%. Vitamin D deficiency among young and middle age Saudi Arabian males could lead to serious health consequences if the issue is not urgently addressed.
doi:10.4103/0256-4947.55168
PMCID: PMC3290044  PMID: 19700896
5.  Which one is the urinary bladder? 
Annals of Saudi Medicine  2009;29(5):410-411.
PMCID: PMC3290045  PMID: 19700903
6.  Prevalence of oral lesions among Saudi dental patients 
Annals of Saudi Medicine  2009;29(5):365-368.
BACKGROUND AND OBJECTIVES:
Few studies have been conducted in the Saudi population on oral mucosal lesions. The purpose of this study was to evaluate the type and extent of oral lesions in a study among dental patients at a college of dentistry in Saudi Arabia.
PATIENTS AND METHODS:
Over a 3-year period, 2552 dental outpatients were interviewed and investigated clinically for the presence of oral mucosal conditions. A thorough oral clinical examination was performed, including a radiographic examination. The diagnosis was confirmed histopathologically when necessary.
RESULTS:
Of 383 (15.0%) patients found to have oral mucosal lesions, females constituted 57.7% (n=221) and males 42.3% (n=162). The age range of the patients was between 15 to 73 years with a mean age of 38.2 years. The most commonly affected age group was 31 to 40 years, which comprised 21.4% (n=82) of all affected individuals. The least affected age group were individuals older than 61 years. The most common lesion was Fordyce granules (3.8%; n=98), followed by leukoedema (3.4%; n=86) and traumatic lesions (ulcer, erosion) in 1.9% (n=48). Tongue abnormalities were present in 4.0% (n=101) of all oral conditions observed, ranging from 1.4% (n=36) for fissured tongue to 0.1% (n=2) for bifid tongue. Other findings detected were torous platinus (1.3%; n=34), mandibular tori (0.1%; n=2) aphthous ulcer (0.4%; n=10), herpes simplex (0.3%; n=7), frictional hyperkeratosis (0.9%; n=23), melanosis (0.6%; n=14), lichen planus (0.3%; n=9) and nicotinic stomatitis (0.5%; n=13).
CONCLUSION:
The findings of this study provide information on the types and prevalence of oral lesions among Saudi dental patients. This provides baseline data for future studies about the prevalence of oral lesions in the general population.
doi:10.4103/0256-4947.55166
PMCID: PMC3290046  PMID: 19700894
7.  Ileosigmoid knot: a case report and literature review of 280 cases 
Annals of Saudi Medicine  2009;29(5):402-406.
Ileosigmoid knotting, also known as compound volvulus or double volvulus, is a rare cause of intestinal obstruction. In this condition the ileum wraps around the base of the sigmoid colon and forms a knot. Ileosigmoid knotting is an unusual entity in the West, but is comparatively common in certain African, Asian and Middle Eastern nations. The condition is serious, generally progressing rapidly to gangrene. Awareness of the condition is essential for prompt diagnosis and optimal management. This report describes a case in a 60-year-old male and describes the management of this rare condition. An additional 280 recent cases in the English literature are reviewed as to etiopathogenesis, presentation, diagnostic modalities, surgical interventions and outcome.
doi:10.4103/0256-4947.55173
PMCID: PMC3290047  PMID: 19700901
9.  Management of ascites due to gastrointestinal malignancy 
Annals of Saudi Medicine  2009;29(5):369-377.
Ascites is the pathological accumulation of fluid within the abdominal cavity. The most common cancers associated with ascites are adenocarcinomas of the ovary, breast, colon, stomach and pancreas. Symptoms include abdominal distension, nausea, vomiting, early satiety, dyspnea, lower extremity edema, weight gain and reduced mobility. There are many potential causes of ascites in cancer patients, including peritoneal carcinomatosis, malignant obstruction of draining lymphatics, portal vein thrombosis, elevated portal venous pressure from cirrhosis, congestive heart failure, constrictive pericarditis, nephrotic syndrome and peritoneal infections. Depending on the clinical presentation and expected survival, a diagnostic evaluation is usually indicated as it will impact both prognosis and the treatment approach. Key tests include serum albumin and protein and a simultaneous diagnostic paracentesis, checking ascitic fluid, WBCs, albumin, protein and cytology. Median survival after diagnosis of malignant ascites is in the range of 1 to 4 months; survival is apt to be longer for ovarian and breast cancers if systemic anti-cancer treatments are available.
doi:10.4103/0256-4947.55167
PMCID: PMC3290049  PMID: 19700895
10.  Priapism as the first manifestation of chronic myeloid leukemia 
Annals of Saudi Medicine  2009;29(5):412.
doi:10.4103/0256-4947.55176
PMCID: PMC3290050  PMID: 19700904
11.  Body mass index in Saudi Arabian children and adolescents: a national reference and comparison with international standards 
Annals of Saudi Medicine  2009;29(5):342-347.
BACKGROUND AND OBJECTIVES:
Because there are no reference standards for body mass index (BMI) in Saudi children, we established BMI reference percentiles for normal Saudi Arabian children and adolescents and compared them with international standards.
SUBJECTS AND METHODS:
Data from a stratified multistage probability sample were collected from the 13 health regions in Saudi Arabia, as part of a nationwide health profile survey of Saudi Arabian children and adolescents conducted to establish normal physical growth references. Selected households were visited by a trained team. Weight and length/height were measured and recorded following the WHO recommended procedures using the same equipment, which were subjected to both calibration and intra/interobserver variations.
RESULTS:
Survey of 11 874 eligible households yielded 35 275 full-term and healthy children and adolescents who were subjected to anthropometric measurements. Four BMI curves were produced, from birth to 36 months and 2 to 19 years for girls and boys. The 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th, and 97th percentiles were produced and compared with the WHO and CDC BMI charts. In the higher percentiles, the Saudi children differed from Western counterparts, indicating that Saudi children have equal or higher BMIs.
CONCLUSION:
The BMI curves reflect statistically representative BMI values for Saudi Arabian children and adolescents.
doi:10.4103/0256-4947.55162
PMCID: PMC3290051  PMID: 19700890
12.  The prevalence of metabolic syndrome and cardiovascular risk factors in a group of obese Saudi children and adolescents: A hospital-based study 
Annals of Saudi Medicine  2009;29(5):357-360.
BACKGROUND AND OBJECTIVES:
We assessed the distribution of risk factors associated with the metabolic syndrome in a group of obese Saudi children and adolescents. No previous studies had addressed this issue in the Saudi pediatric population.
SUBJECTS AND METHODS:
We retrospectively reviewed the medical records of patients evaluated for obesity between 2004 and 2008 and collected data on age, weight, height, body mass index (BMI), BP, fasting lipid profile, fasting glucose, insulin concentrations, and insulin resistance based on the homeostasis assessment model-insulin resistance (HOMA-IR) score. Obesity was defined as a BMI above the 95th percentile for age and gender and metabolic syndrome was diagnosed according to standard criteria.
RESULTS:
We studied 57 obese Saudi children and adolescents with a mean (standard deviation) age of 9.8 (3.5) years. Mean weight and body mass index (BMI) were 63.7 (28.3) kg and 31.6 (8.0) kg/m2, respectively. Systolic BP was elevated in 24 (42%) of the 57 subjects. Of the 39 children who had a lipid profile in their records, 10 had hypertriglyceridemia, 8 had hypercholesterolemia, 6 had elevated LDL cholesterol levels, and 6 had low HDL cholesterol levels. Impaired fasting glucose was found in 10 of 38 patients in which it was measured, and 9 of 25 patients had fasting hyperinsulinemia. Eleven of 37 patients (29.7%) met the diagnosis of the metabolic syndrome. Diastolic BP correlated positively with BMI (r=0.440, P=.001), and HDL cholesterol correlated negatively with weight and BMI (r=−0.487, P=.002 and r=−0.317, P=.05). HOMA-IR correlated positively with BMI and triglyceride levels and negatively with HDL cholesterol levels.
CONCLUSION:
Obese Saudi children and adolescents have multiple risk factors associated with metabolic syndrome.
doi:10.4103/0256-4947.55164
PMCID: PMC3290052  PMID: 19700892
13.  An unusual cause of gastric outlet obstruction: A pancreaticoduodenal artery aneurysm 
Annals of Saudi Medicine  2009;29(5):393-396.
We present a rare case of gastric outlet obstruction due to compression of the duodenum by a pancreaticoduodenal artery (PDA) aneurysm 2.5 cm in diameter, in a 43-year-old man from Saudi Arabia who presented with persistent vomiting and epigastric pain. The initial investigations and blood works were negative, and esophagogastroduodenoscopy (EGD) was unremarkable. A CT abdomen demonstrated a mass around the duodenum and dilatation of the stomach, and CT angiography showed the PDA aneurysm. The patient was stabilized and then referred to a tertiary center for embolization. Our case demonstrates a diagnostic challenge that physicians may encounter in patients who present with vomiting and epigastric pain.
doi:10.4103/0256-4947.55171
PMCID: PMC3290053  PMID: 19700899

Results 1-13 (13)