Background: An appendix mass is the result of a walled-off perforation of the appendix which localizes, resulting in a mass and it is encountered in up to 7% of patients presenting with acute appendicitis. The management of such problem is controversial. Immediate appendectomy may be technically demanding. Traditionally, management of these patients is conservative followed by interval appendectomy to prevent recurrence. However, the need for interval appendectomy has recently been questioned due to relatively small risk of recurrence. Also, there is still debate on adopting conservative management regarding the recurrence rate, the complication rate of interval appendectomy, and the potential for underlying malignancy. Our aim was to assess the preferred approach and current practice for management of acute appendix mass among surgeons in Al Taif Saudi Arabia.Methods: A questionnaire for the practice of surgeons in dealing with appendicular mass was designed and distributed to 21 consultants and 45 specialists.Results: 14.3% of consultant and 53.3% of specialist practiced the conservative management without routine interval appendectomy. Also, 14.3% and 26.7% of them respectively preferred immediate appendectomy while 71.4% of consultants and 20.0% of specialists did routine interval appendectomy. Most of the surgeons prefer to adopt the open method in immediate appendectomy while laparoscopic approach is the main adopting procedure for interval appendectomy. 57% of consultants stated risk of recurrence as the reason for performing interval appendectomy while, 53.4% of specialists would perform it to out-ruling neoplasm.Conclusions: Surgeons prefer to carry conservative approach with an interval appendectomy in management of appendix mass and laparoscopic approach for interval appendectomy. However immediate appendectomy and conservative management without interval appendectomy was preferred in other studies, which increase the necessity for national guidelines to be considered for management of this clinical condition.

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Background and aim of the work: Therapeutic uniportal video-assisted thoracic surgery (VATS) has less postoperative pain, shorter hospital stay, and less operative time.

Background and aim of the work: Recent studies revealed that hypobaric hypoxia stimulates release of vascular endothelial growth factor (VEGF) and other studies found that high levels of this angiogenic factor are correlated with poor prognosis in patients with non-small cell lung cancer (NSCLC). In this study we will measure the serum levels of VEGF in both healthy individuals and in patients with operable non small cell lung carcinoma living in hypobaric oxygen environment (Taif) and validate the prognostic significance of its pretreatment level in those patients. Patients and methods: Thirty one patients with operable (stage I, II and III A) non-small cell lung cancer (the patient group) and 15 healthy volunteers with matched gender and age (control group) were enrolled in this study from January 2010 to March 2015. The pretreatment level of VEGF was measured in patients in addition of its level in controls. All patients had the same diagnostic and therapeutic protocols. Mean follow up of patients was 30.4±7.8 months. Results: The mean level of VEGF was high in control group, however, it was significantly lower than that in patient group (P value 0.041). The median survival of stage I patients was 13 months, stage II was 9 months, and of stage III A was 6 months. Univariate analysis showed a significant correlation between survival and pretreatment level of VEGF in patients with small lung cancer. Conclusions: Our results revealed that hypobaric hypoxia significantly increases the circulating levels of VEGF in healthy individuals without remarkable effect on its level in patients with NSCLC. Our study verified also that the pretreatment mean serum level of VEGF showed a highly significant increase in NSCLC patients than that in control group and it was significantly correlated with patient survival in levels above 618 pg/ml.

Background and aim of the work: several studies suggest that proton pump inhibitors (PPIs) use may be involved in development and acceleration of osteoporosis. The aim of this study is to investigate the relationships between prolonged uses of PPIs in patients with gastro-esophageal reflux disease (GERD) and to reveal their possible role in development of osteopenia or osteoporosis with evaluation of different diagnostic tools which help in follow up of those patients. Patient and methods: This prospective controlled study which was conducted at King Abdul Aziz Specialist Hospital in Taif, Saudi Arabia, from January 2013 to June 2016. We compared the prevalence of osteoporosis or osteopenia in 2 groups of individuals, the first group; of 30 patients using PPIs as treatment of GERD for more than 2 years. The second group included thirty healthy control subjects .In both groups we measured the bone mineral density using the dual energy X-ray absorptiometry (DEXA), calcium (Ca), inorganic phosphorus (P), serum alkaline phosphatase, and deoxypyridinoline (DPD) in urine. Results: there were no significant differences between the 2 groups as regards, age, gender, and their clinical history (P > 0.05), however, the history of fragility fracture was significantly higher in PPIs group of patients (P< 0.05). The means of antroposterior spine and left femur BMD-T scores were lower than normal in both groups; however, it was significantly lower in PPIs group than in control group (P< 0.05). Serum calcium was slightly lower than the reference range with normal phosphorus level without significant difference between both groups (P> 0.05). The serum alkaline phosphatase and urinary DPD were higher than normal reference levels, but, significantly higher in patients receiving PPIs (P< 0.05). The number of osteopenic/osteoporotic patients was significantly higher in PPIs group than in control group (P< 0.05). Osteopenia and osteoporosis were significantly correlated in PPIs group with male gender, younger age group of patients (P< 0.05), and the correlation was highly significant with the duration of use of the drug (P<0.001). In control group the decrease in bone density was significantly correlated with the female gender and to older group of patients (P< 0.05). Conclusion: in GERD patient using PPIs, the osteopenic/osteoporotic effect with increased possibility of fragility fractures must be discussed with the patient if prolonged use of these drugs is expected, taking in consideration the potential safety and reliability of laparoscopic or thoracoscopic surgical options as alternative therapy.