Farhan Rashid

A pre-operative elevated neutrophil: lymphocyte ratio does not predict survival from oesophageal cancer resection

BackgroundElevated pre-operative neutrophil: lymphocyte ratio (NLR) has been identified as a predictor of survival in patients with hepatocellular and colorectal cancer. The aim of this study was to examine the prognostic value of an elevated preoperative NLR following resection for oesophageal cancer.MethodsPatients who underwent resection for oesophageal carcinoma from June 1997 to September 2007 were identified from a local cancer database. Data on demographics, conventional prognostic markers, laboratory analyses including blood count results, and histopathology were collected and analysed.ResultsA total of 294 patients were identified with a median age at diagnosis of 65.2 (IQR 59-72) years. The median pre-operative time of blood sample collection was three days (IQR 1-8). The median neutrophil count was 64.2 × 10-9/litre, median lymphocyte count 23.9 × 10-9/litre, whilst the NLR was 2.69 (IQR 1.95-4.02). NLR did not prove to be a significant predictor of number of involved lymph nodes (Cox regression, p = 0.754), disease recurrence (p = 0.288) or death (Cox regression, p = 0.374). Furthermore, survival time was not significantly different between patients with high (≥ 3.5) or low (< 3.5) NLR (p = 0.49).ConclusionPreoperative NLR does not appear to offer useful predictive ability for outcome, disease-free and overall survival following oesophageal cancer resection.

A review article on gastric volvulus: A challenge to diagnosis and management

Acute gastric volvulus is a life-threatening condition, but its intermittent nature and vague symptoms may make diagnosis difficult. Imaging is usually only diagnostic if carried out when patients are symptomatic. The population affected ranges from paediatric age group to elderly with multiple co-morbidities. Laparoscopic repair is advisable once a diagnosis is reached. This review on gastric volvulus focuses on the diagnostic and management challenges encountered, together with strategies for dealing with them. Lessons have emerged which may assist in dealing with such a rare presentation in future.

A review on gastric diverticulum

The gastric fundal diverticulae are rare. They can present with variable symptoms. We are enclosing a literature review on gastric fundal diverticulum. Lessons have emerged which may help in the management of this rare condition in future.

Probing the link between oestrogen receptors and oesophageal cancer

BackgroundHuman oesophageal carcinoma is considered to be one of the most aggressive malignancies and has a very poor prognosis. The incidence of oesophageal cancer shows a gender bias and is higher in males compared with females, the ratio between males and females varying from 3:1 to 7:1. This sex ratio is not entirely attributable to differences in the prevalence of known risk factors between the sexes. The potential role of oestrogen receptors (ER) in oesophageal cancer has been debated for several years but the significance of the receptors in this cancer remains unknown. Most of the work has been based on immunohistochemistry and has not been validated with other available techniques. The inconsistencies in the published literature on the link between ER expression and oesophageal cancer warrant a thorough evaluation of the potential role of ERs in this malignancy. Even the expression of the two ER isoforms, ERα and ERβ, and its implications for outcome of treatments in histological subtypes of oesophageal tumours is ill defined. The aim of this article is to provide updated information from the available literature on the current status of ER expression in oesophageal cancer and to discuss its potential therapeutic role.Methods and ResultsWe performed a comprehensive literature search and analysed the results regarding ER expression in oesophageal tumours with special emphasis on expression of different oestrogen receptors and the role of sex hormones in oesophageal cancer. This article also focuses on the significance of the two main ER subtypes and mechanisms underlying the presumed male predominance of this disease.ConclusionWe postulate that differential oestrogen receptor status may be considered a biomarker of poor clinical outcome based on tissue dedifferentiation or advanced stage of the disease. Further, if we can establish the importance of oestrogen and its receptors in the context of oesophageal cancer, then this may lead to a new future direction in the management of this malignancy.

Swallowed dental bridge causing ileal perforation: a case report

We report the case of a 53 year old gentleman who had accidentally swallowed his dental bridge. One week following this he experienced a sudden onset of generalised abdominal pain and underwent laparotomy. At operation he was found to have a distal ileal perforation and an ileocaecal resection was performed. Although most swallowed foreign bodies pass through the gastrointestinal tract without problem, serious complications including intestinal perforation can occur.

Magnetised intragastric foreign body collection and autism An advice for carers and literature review

The pica phenomenon, where non-edible substances are repeatedly consumed, has been linked with developmental and behavioural disorders, particularly autism. The clinical presentation of foreign body ingestion in patients with autism is discussed, and recommendations for caregivers are provided based on the available literature. An 18-year-old man with severe autism and behavioural difficulties presented with a vague history of decreased appetite and melaena of eight months duration. Foreign body ingestion commonly occurs in individuals with autism spectrum disorders and should be suspected in patients who present with vague gastrointestinal symptoms. The adverse medical and surgical consequences of foreign body ingestion emphasize the need for early recognition. Surgical intervention for foreign body ingestion can prevent complications. Magnetic substances can cause considerable gastrointestinal morbidity and require urgent endoscopic or surgical removal. Primary prevention is also vital.

Troublesome belching with fetor odour

A 37-year-old lady presented with a 5-month history of upper abdominal pain, belching with odour which was occasionally feculent. She also noticed intermittent postprandial epigastric fullness associated with excessive burping. The …

Atypical right diaphragmatic hernia (hernia of Morgagni), spigelian hernia and epigastric hernia in a patient with Williams syndrome: a case report.

IntroductionWilliams syndrome is rare genetic disorder resulting in neurodevelopmental problems. Hernias of the foramen of Morgagni are rare diaphragmatic hernias and they mostly present on the right side, in the anterior mediastinum. They are usually asymptomatic and are difficult to diagnose, especially in patients with learning disabilities.Case presentationThis 49-year-old woman with Williams syndrome, cognitive impairment and aortic stenosis presented to physicians with right-sided chest pain. She had previously undergone repair of her right spigelian and epigastric hernia. Her abdominal examination was unremarkable. Chest X-ray suggested right-sided diaphragmatic hernia and pleural effusion for which she received treatment. The computed tomography scan showed a diaphragmatic hernia with some collapse/consolidation of the adjacent lung. Furthermore, the patient had aortic stenosis and was high risk for anaesthesia (ASA grade 3). She underwent successful laparoscopic repair of her congenital diaphragmatic hernia leading to a quick and uneventful postoperative recovery.ConclusionThese multiple hernias suggest that patients with Williams syndrome may have some connective tissue disorder which makes them prone to develop hernias especially associated with those parts of the body which may have intracavity pressure variations like the abdomen. Diaphragmatic hernia may be the cause of chest pain in these patients. A computed tomography scan helps in early diagnosis, and laparoscopic repair helps in prevention of further complications, and leads to quick recovery especially in patients with learning disabilities. In the presence of significant comorbidities, a less invasive operative procedure with quick recovery becomes advisable.

Acute mesenteric ischemia and duodenal ulcer perforation: a unique double pathology

BackgroundAcute mesenteric ischaemia and duodenal perforation are surgical emergencies with serious consequences. Patients presenting with acute mesenteric ischaemia alone face a high mortality rate as high as 60% whereas those presenting with peptic ulcer perforation the mortality rates range from 6-14%. There are very few reported cases of patients presenting with this dual pathology.Case presentationWe report a unique case of a 53 year old Italian lady who presented with acute mesenteric ischaemia and duodenal perforation. This is the first report of massive bowel ischaemia and duodenal perforation with no apparent underlying common pathophysiology leading to this presentation.ConclusionEarly management in the intensive care unit and appropriate surgical intervention maximised the patient’s chances of survival despite the poor prognosis associated with her dual pathology. The rare pathology of the patient described can be explained by two possible hypotheses: peptic ulcer disease causing duodenal ulceration, which precipitated ischaemic infarction of the small bowel. The second hypothesis is the patient developed a stress related ulcer following ischaemic bowel infarction secondary to arterial thrombosis.

Accidental finding of a toothpick in the porta hepatis during laparoscopic cholecystectomy: a case report

IntroductionUnintentional ingestion of a toothpick is not an uncommon event. Often the ingested toothpicks spontaneously pass through the gut without sequelae. However, serious complications can happen when these sharp objects migrate through the gastrointestinal wall.Case presentationIn the current report, we describe the case of a 37-year-old Caucasian woman with an incidental finding of a toothpick in the porta hepatis during laparoscopic cholecystectomy for symptomatic gall stones.ConclusionToothpick ingestion is not an uncommon event and can predispose patients to serious complications. In this particular case, the toothpick was only discovered at the time of unrelated surgery. Therefore, it was important during surgery to exclude any related or missed injury to the adjacent structures by this sharp object.