Pre-operative blood donation: A Saudi experience.

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The role of fine needle aspiration biopsy and frozen section in the management of nodular thyroid lesions.

Full text is available as a scanned copy of the original print version.

Laparoscopic cholecystectomy for acute cholecystitis.

One hundred and eight patients with histopathologically confirmed acute cholecystitis underwent laparoscopic or attempted laparoscopic cholecystectomy in the Security Forces Hospital, from October 1991 to April 1996 were retrospectively reviewed. All the patients had routine laboratory works including abdominal ultrasonography. Females represented 75% and 57% had previous admission. Diabetes mellitus was found in 43.5%. Laparoscopic cholecystectomy was successfully completed in 71.2%. The main reasons for conversion in 31 patients were adhesions and unclear anatomy in 87%. The mean operative time was 96 minutes. Laparoscopic cholecystectomy for acute cholecystitis can be a safe and effective alternative to open cholecystectomy provided a safe dissection of the ductal and vascular anatomy with liberal attitude towards conversion is adopted. Patients presenting with leukocytosis> 15,000/mm3, mass or diabetes are the most likely to be converted to open surgery.

Operative cholangiography in laparoscopic cholecystectomy: Is it essential?

This study is to evaluate the need for preoperative cholangiography during laparoscopic cholecystectomy when endoscopic retrograde cholangiopancreatography (ERCP) is available. Over a period of four years, 1105 consecutive patients had laparoscopic cholecystectomy. All patients, in addition to their clinical assessment, had routine liver function tests (LFTs) and ultrasound (US) examination of the biliary tract. Preoperative ERCP was performed (diagnostic and/or therapeutic) in 107 (9.6%) of the patients. The indications for ERCP were one or more of the following: 1) abnormal liver function test, 74 patients; 2) jaundice, 37 patients; 3) common bile duct (CBD) stone seen in US, 36 patients, and/or CBD dilatation, 46 patients; and 4) pancreatitis, 20 patients. In 41 out of 107 (38%) patients, CBD stones were present and cleared endoscopically. Postoperative ERCP was necessary in eight patients: to remove retained stones in the CBD (two patients), to stop bile leak (two patients), and to investigate the persistent abnormal LFTs in the remaining patients. The number of patients who had evidence of retained CBD stone following laparoscopic cholecystectomy was only two. In both patients, endoscopic removal was successful. Therefore, it is clear that operative cholangiography in laparoscopic cholecystectomy is not essential if there is a reasonable facility for ERCP.

Necrotizing enterocolitis, surgical experience.

Between January 1988 and December 1994, 29 cases of necrotizing enterocolitis (NEC) required surgical management. There were 15 males and 14 females. The gestational age range was 24-38, average 32.7 weeks and body weight range was 565-4500 grams, average 1,680 grams. Necrotizing enterocolitis developed within two weeks of age in 55% of the cases, between two and four weeks in 34% and beyond four weeks in four cases (14%). Pneumoperitoneum was the commonest indication for surgery (55%) of cases, followed by failure of response to medical treatment. The commonest surgical procedure was resection of the gangrenous bowel with creation of an enterostomy for the segmental disease in 15 cases (50%) and resection with primary anastomosis in six cases (20%). Four cases (14%) had NEC totalis for which drainage alone was done, and two cases had external drainage alone. Survival rate was 72%.

Trauma cases admitted to the surgical intensive care unit--progress and outcome.

A review of the trauma admissions to the Surgical Intensive Care Unit (SICU) at King Khalid University Hospital, Riyadh during the period from 30 October 1984 to 29 October 1989 was made. A total of 181 cases constituting 15.7% of the total surgical admissions to the unit during that period were recognised. The main cause of the trauma was road traffic accidents (83.4%). The male to female ratio in this group was 6.3:1. Thirty patients died in the SICU, 16 died within 24 hours of admission to the unit and the remaining 14 developed multiple organ failure prior to death. Positive cultures from different sites were obtained from 50% of them. Recommendations are made to improve the management of similar cases.

A comparative ultrasound and plain abdominal x-ray: Evaluation of non-classical clinical cases of appendicitis.

A prospective study of 109 patients with non-classical symptoms of appendicitis using the standard ultrasound (US) machine and plain abdominal x-rays demonstrated that US was superior to plain x-ray with a sensitivitiy, specificity and overall accuracy of 89%, 96% and 91%, respectively as compared with plain x-ray with 48%, 93% and 67% respectively. The negative appendectomy rate was 7%. In the alternative diagnosis, plain x-ray was superior to US due to the prevalence of intestinal diseases, ureteric calculi and basal pneumonia which were best shown in plain x-rays. US was, however, most useful in detecting female pelvic pathology. It is hoped that with improved imaging expertise and the appication of high resolution US machine a higher sensitivity and accuracy can be achieved. US is therefore recommended as the first line in the imaging of non-classical cases of appendicitis. However, in areas where enteric diseases and urinary calculus are endemic, it is prudent to perform both ultrasound and plain abdominal x-rays while the patient is in the radiodiagnostic department.

Assessment of severity in acute pancreatitis: Use of prognostic factors.

This prospective study evaluates the value of Ranson's prognostic factors in predicting severity of acute pancreatitis. One hundred-fourteen patients with 124 attacks of acute pancreatitis were studied duringa 4-year period at Riyadh Central Hospital. The majority of patients were Saudi males, their mean age being 46.5 years. Cholelithiasis was the leading cause of pancreatitis. Ranson's 11 prognostic factors were estimated within 48 hours of admission. Sixty-six percent of the cases were graded as mild pancreatitis with less than 3 Ranson's factors present, whereas 34% were classified as severe pancreatitis with 3 or more of Ransosn's factors present. Prognostic factors correctly predicted severity in 6% of patients, but only 36% from the severe group developed severe disease (complications and/or death). Overall mortality was 5.3%. Ranson's prognostic factors help in identifying severe pancreatitis but their accuracy may be improved by the use of modern imaging techniques.

Management of colon injuries.

The controversy regarding the management of colon injuries continues, some favouring primary repair while others lean towards a proximal defunctioning procedure. We have reported our experience in this field over a 4-year period. Forty-three patients with large bowel injuries were treated during this period and two of them died in the immediate postoperative period due to continued haemorrhage. Of the remaining 41 patients, 27 underwent primary repair of the colon and 15 per cent of them developed complications. Fourteen patients had a proximal defunctioning procedure and 50 per cent of them developed complications. When severity of injuries was taken into consideration it showed a linear relationship to complications. We conclude that primary repair of the colon should be the preferred method of treatment in patients with grade I and II injuries.

Pattern of primary gastrointestinal tract malignancy among Saudi nationals: A retrospective study.

This histopathological reports from the central laboratory of Riyadh Central Hospital for between 1404 to 1406H (1984 to 1986) were reviewed retrospectively to determine the pattern of primary cancer of the gastrointestinal tract among Saudi nationals. During the study period, a total of 32,990 histopathological examinations were conducted. Neoplasms were identified in 4683 cases (14.2%); 1772 (37.8%) were malignant and 2911 (62.2%) were benign. The stomach (31%), liver (20%), and esophagus (19%) were the most commonly involved organs. The proportional frequencies of gastrointestinal malignancies differ from those seen in Western countries, although the age and sex distribution are similar. The possible etiological factors are discussed and the need for a cancer registry emphasized.

Acute appendicitis complicating pregnancy.

Appendicitis occurring during pregnancy presents a difficult problem for both the treating gynecological and the surgeon. We studied retrospectively the cases of 52 consecutive patients seen during a four-year period at Riyadh Central Hospital, a large and busy general hospital. The incidence of appendicitis in various stages of pregnancy, along with its symptomatology, physical signs, laboratory results, and operative findings, were analyzed. The rates of complications, especially maternal and fetal mortality, were also analyzed and findings compared with those reported elsewhere. There was no maternal morbidity and a 4% fetal mortality. We concluded that an aggressive approach in the diagnosis and surgical management of these patients reduces the maternal and fetal mortality.

Traumatic hernia of the abdominal wall.

Traumatic hernia of the abdominal wall is unusual and even more so the complete avulsion of muscles from the costal arch. While it is usual to search carefully for diaphragmatic hernia during laparotomy for blunt abdominal trauma, traumatic hernia of the abdominal wall of this nature can be easily overlooked. One such case in a child is presented where the diagnosis was not made at the initial laparotomy following blunt abdominal injury received in a road traffic accident. We believe bilateral avulsion of all the abdominal wall muscles from the costal arch has not been reported before.