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Background: Transesophageal endoscopic plication (TEP) is a novel endotherapeutic approach in the management of gastroesophageal reflux disease (GERD). This non-randomized prospective study compares TEP with laparoscopic Nissen fundoplication (LNF)., Methods: Twenty-four consecutive patients treated with LNF, and 27 managed by TEP were studied. Symptom severity scores, endoscopy, 24 h esophageal pH and esophageal manometry and quality-of-life assessments were obtained pre- and posttreatment., Results: In the LNF group the mean age was 36 yr (17-68) compared with 39 yr (22-62) in the TEP group. Symptom scoring, acid regurgitation score, reduction in the requirements of proton pump inhibitors (PPIs), and quality of life remained significantly improved in both groups at a median of 1 yr [10-18 months] follow-up post procedure. However, the improvement was significantly better in symptom score (p= 0.0383) and the control of acid reflux in the LNF group (p= 0.0007). Post-procedure dysphagia was more common in the LNF group., Conclusion: Both techniques improved symptom score, acid regurgitation, quality of life, and reduced the requirements for PPIs. The control of heartburn and acid reflux was better for LNF. TEP, like LNF, is a safe and effective method of management of symptomatic GERD but further developments are necessary to ensure control of esophageal acid reflux.

An anomalous course of the left anterior descending artery is a rare but potentially fatal condition. We herein describe the treatment and management of a patient who was diagnosed with this ailment.

Separately collected urine ("yellow water") can be utilized as fertilizer. In order to decrease storage volumes and energy consumption for yellow water transport to fields, enrichment of nutrients in yellow water has to be considered. Laboratory-scale batch freeze concentration of yellow water has been tested in ice-front freezing apparatus: a stirred vessel and a falling film freeze concentrator (coolant temperatures: -6 to -16 degrees C). With progressing enrichment of the liquid concentrate, the frozen ice was increasingly contaminated with yellow water constituents (ammonia, total nitrogen, total phosphorus, TOC, and salts determined as conductivity). The higher the initial salinity of the yellow water and the lower the mechanical agitation of the liquid phase contacting the growing ice front, the more the frozen ice was contaminated. The results indicate, that in ice-front freezing devices multistage processes are necessary, i.e. the melted ice phase has to be purified (and the concentrates must be further enriched) in a second or even in a third stage. Energy consumption of this process is very high. However, technical scale suspension freeze concentration is reasonable in centralized ecological sanitation schemes if the population exceeds 0.5 million and distance of yellow water transportation to fields is more than 80 km.

Background: Gastro-oesophageal reflux disease (GORD) is, in the main, treated with either proton pump inhibitor (PPI) drugs or a Nissen fundoplication operation. Recently, BARD developed Endocinch, a device used to place sutures just below the oesophagogastric junction (OGJ) to treat GORD., Aim: To evaluate the long term benefit of the Endocinch technique in patients seen up to 12 months post procedure., Patients: Twenty six patients with symptoms of GORD were recruited and had the procedure performed. Four patients were lost to follow up., Methods: Twenty two patients completed their one year follow up. Pre procedure and post procedure (up to 12 months) assessments included symptom scoring (DeMeester), upper intestinal endoscopy, oesophageal manometry and 24 hour oesophageal pH, and completion of quality of life (QOL) questionnaires., Results: Mean age was 39 years (range 22-62). Heartburn symptom score was reduced from a mean value of 19.22 at baseline to 7.5 at 12 months (n=22) (p<0.0001). Regurgitation score reduced from a mean of 2.27 at baseline to 0.86 at 12 months (n=22) (p<0.001). Mean (SEM) pH DeMeester acid score was reduced from 44.1 (4.3) to 33.32 (4.73) (p=0.028) at three month post procedure. Percentage upright acid exposure and number of reflux episodes were also reduced significantly. Use of PPIs was reduced by 64% at 12 months post procedure. All QOL assessments showed significant improvement (p=0.01). All transient post procedure complaints resolved within 72 hours., Conclusion: The Endocinch procedure is an effective and safe outpatient procedure that offers GORD patients significant improvement in symptomatology, QOL, and reduced requirements for PPIs over at least a one year period.

Background: Gastro-oesophageal reflux disease (GORD) is a common disorder which significantly impairs the quality of life. Recently a number of endoscopic antireflux procedures have been described, with a view to the management of GORD, thus obviating the need for long-term proton pump inhibitors and the cost and potential risk of laparoscopic Nissen fundoplication., Aim: To evaluate the status of new techniques using gastro-intestinal endoscopy for the management of GORD., Methods: Review of the literature (publications and abstracts) regarding safety, efficacy, and durability of these new antireflux procedures., Results: These antireflux techniques have produced significant improvement in GORD symptomatology and quality of life and have reduced the use of antireflux medication, without causing serious morbidity or mortality. However, the majority of these techniques have failed to adequately control oesophageal acid reflux., Conclusions: Endoscopic antireflux therapies have the potential to treat patients with GORD. However, further studies are necessary to determine what modifications to these techniques are required in order to produce the maximum clinical efficacy and durability., (Copyright 2002 S. Karger AG, Basel)

Objective: To study the validity and feasibility of a computerized version of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index., Methods: Thirty patients with osteoarthritis (OA) of the knee completed both a paper and a computerized version of WOMAC in random order. The visual analog scaled version of WOMAC, VA3.0, was used. We studied criterion validity by comparing the paper and computerized versions., Results: All patients completed the computerized version without undue difficulty. Criterion validity, based on aggregated subscale scores, was excellent: Pain, ICC = 0.89, Stiffness, ICC = 0.87, Physical Function, ICC = 0.95., Conclusion: The computerized version of WOMAC VA3.0 is a valid alternative to the paper version.

We present a 64-year-old Malay lady who had undergone a choledochoduodenostomy (CDD) two years ago for obstructive jaundice. She was admitted with jaundice and underwent ultrasonography, percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangio pancreatography (ERCP) and computed tomographic (CT) scanning of the liver and biliary tree. All the investigations confirmed a type IVa choledochal cyst. At operation, the grossly dilated biliary system was packed with a thick mucoid material and the mucosa of the bile ducts was visibly abnormal with scattered nodules. This mucoid material had caused occlusion of the entire biliary tree resulting in obstructive jaundice. To the best of our knowledge, this is probably the first report of obstructive jaundice caused by thick mucus. The peculiar management problems of this case and the risk of malignant change in choledochal cysts are discussed.

"This paper examines the impact of labour emigration on the wages of both the skilled and unskilled workers....Using... Pakistani data, it is found that unskilled labour is used extremely intensively in the agriculture sector (exportable), skilled labour is used extremely intensively in the manufacturing sector (importable), and capital is used as the middle factor in both the traded goods sectors. Moreover, capital is used significantly less intensively in the construction (non-traded) sector relative to both the traded sectors.... The results suggest that the higher wages to both the skilled and unskilled workers must be compensated by a reduction in the rate of returns to capital if export-oriented and import-competing sectors in Pakistan are to remain internationally competitive.", (excerpt)

Medical research in Pakistan has gained momentum over the past several years. However, the logical conclusions based on information and data are rarely witnessed. This could be due to the fact that medical researchers and doctors are unaware of Biostatistics, its logic, use and inferences to be obtained. Most researches are based on the pattern of works already done elsewhere. Following others blindly generates various snags. In the present study, research articles published during 1986 in the Journal of Pakistan Medical Association (JPMA) and Pakistan Journal of Medical Research (PJMR) are being reviewed with respect to use and abuse of Statistical Methods.

Cognitive dysfunction and solvent abuse have been found to be closely related, but the precise nature of this relationship remains obscure. Twenty eight non-active solvent abusing and 20 non-abusing adolescents were given tests of non-verbal and verbal intelligence, arithmetic, literacy level and learning ability. In addition, they were asked three standard questions about their spare time activities and future orientation. The results clearly indicated that, while the two groups did not significantly differ in potential abilities, the abusers performed significantly poorly on all but one test of acquired abilities. The abusers were found to be less future orientated, were 'bored' with themselves. The aetiological implications of the study are discussed.

21 Subjects awaiting open-heart surgery were given personality and attitude questionnaires. They were re-tested six months after the operation, when they were divided into "completely recovered" (I) and "not completely recovered" (II) groups, according to the New York Heart Association classification. Results showed that Group I was significantly less depressed, more optimistic about the future and had a more positive attitude towards others. Group II realised they had been very ill and had a more negative attitude towards their spouses. Group I was found to be much better adjusted, vocationally and psychosexually, than Group II.

Of 49 schizophrenic patients followed up 2 years after their first admission to hospital, 37% were well, 47% had been readmitted to hospital at some time over the 2 years, and 38% showed schizophrenic symptoms at follow-up. A poor outcome at 2 years was associated with male sex, poor outcome after the first 5 weeks of the first admission, negative schizophrenic symptoms on first admission, and a diagnosis of definite or probable schizophrenia using the Feighner criteria. Only 23% were in employment. A small double-blind discontinuation study of maintenance antipsychotic medication during the second year found more relapses in those switched to placebo medication. Repeat psychometric assessment at 2 years confirmed modest improvements found at 12 months; that is, there was no evidence of intellectual decline. Relatives showed no more psychosocial distress than that found in a normal community sample; what distress there was correlated with patients' schizophrenic symptoms.

In 1192 biopsy proven cases of carcinoma of the oral cavity and oropharynx information was collected on the use of various chewing, smoking, and eating habits. The quantity used and the duration of use were also recorded. Information was also collected on the frequency of use of cereals, dairy products, meat, fish, fruits and vegetables. The information from carcinoma cases was compared with that from apparently healthy individuals.