Prevalence and risk factors of gallstone disease in a high altitude Saudi population.

To study the prevalence of gallstone disease and related risk factors in a Saudi Arabian population a cross-sectional community-based study was made of 291 people from Abha district, Asir region. A structured interview collected background data and all participants had upper abdominal ultrasonography to detect gallstones. The overall prevalence of gallstone disease was 11.7%. Using logistic regression multivariate analysis, the following were significant risk factors for gallstone disease: female sex, family history of gallstone disease and past history of pancreatitis. Age, education, blood pressure, smoking, coffee intake, overweight, diabetes mellitus, number of pregnancies and use of oral contraceptives were not significant risk factors. Discriminant analysis of symptoms showed that only right hypochondrium pain was significantly associated with gallstone disease.

Prevalence and risk factors of gallstone disease in a high altitude Saudi population

To study the prevalence of gallstone disease and related risk factors in a Saudi Arabian population a cross-sectional community-based study was made of 291 people from Abha district, Asir region. A structured interview collected background data and all participants had upper abdominal ultrasonography to detect gallstones. The overall prevalence of gallstone disease was 11.7%. Using logistic regression multivariate analysis, the following were significant risk factors for gallstone disease: female sex, family history of gallstone disease and past history of pancreatitis. Age, education, blood pressure, smoking, coffee intake, overweight, diabetes mellitus, number of pregnancies and use of oral contraceptives were not significant risk factors. Discriminant analysis of symptoms showed that only right hypochondrium pain was significantly associated with gallstone disease

An unusual cause of lower gastrointestinal bleeding: a case report and a review of literature.

This is an unusual case report of a 60-year-old man who presented with massive rectal bleeding due to angiomatous formation. He was also found to be cirrhosis and to have an ectopic left kidney in the midline over the roof of the mesenteric vessel. He was treated successfully by performing a right hemicolectomy.

Traumatic diaphragmatic hernia: an Asir region (Saudi Arabia) experience.

Ten patients (nine males, one female), seen at the Asir Central Hospital of South-Western Saudi Arabia with proven traumatic diaphragmatic hernia between 1987 and 1997, were reviewed retrospectively. The mean age was 29.6 years, range 5 to 50 years. Chest pain and vomiting were the commonest symptoms. Blunt trauma (road traffic accident--5, fall from height--1, (accounted for 60% of the cases) while gunshot wound and stab wounds were the causes in two patients each. The chest radiograph suggested the diagnosis in all the cases. Barium meal (in two patients) and barium enema (in two patients) complemented the diagnosis. Computed tomography (CT) scan was done in only one patient. Thoracotomy (in 2 patients), laparotomy (in 5 patients) and thoraco-laparotomy (in 3 patients) were the surgical approaches to management. Common herniated organs were liver, stomach, spleen and large bowel. The injuries were on the left side in seven patients and on the right side in three cases. Immediate surgical repair was done in four patients while it was done two days to four years later in others. Complications were minimal and there was only one death.

Swallowed foreign body: Is interventional management always required?

A retrospective study of 20 cases diagnosed as "swallowed foreign body" seen over a five-year period (July 1993-June 1998) at Asir Central Hospital was performed. Six (30%) were children and 14 (70%) adults. In the children, five were boys and one was a girl. Objects swallowed included metal nails. coins, hair pins and a chain pendant. In the adult group, eight (57%) were males and six (43%) females. Objects swallowed included sewing needles, sharp blades, pieces of glass, paper clips and gravel. The swallowed foreign body in all the patients passed innocuously through the gastrointestinal tract in two to ten (average 4.7) days. Our method of treatment consisted of giving high fiber diet, Metamucil or lactulose and liquid paraffin. There was no mortality.

Diagnostic yield in barium enema examination.

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Hospital deaths at Asir Central Hospital.

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Radiological evaluation of patients after laparoscopic cholecystectomy.

The objective of this study is to describe the normal, abdominal radiological findings after laparoscopic cholecystectomy that could be confused with a pathological process. Thirty-one patients, who had laparoscopic cholecystectomy were prospectively studied. They underwent supine and erect abdominal X-rays, on the first and second postoperative days. In 19 patients (61 %) no residual free intraperitoneal gas was seen. In 12 patients (39%) small amounts of free gas were noticed 24 hours postoperatively, and in six (19%), some free intraperitoneal gas was seen after 48 hours. Distention of the colon was noticed in 17 (55%), and was mainly in the hepatic flexure area in nine of these patients (29%). Eight patients complained of shoulder pain. This study shows that pneumoperitoneum tends to disappear within 48 hours of laparoscopic cholecystectomy. When present, there is usually no cause for alarm as long as patients show no evidence of clinical disturbance.

Unusual presentations of injury to the bronchus with literature review.

Two patients with unusual presentation of injury to the bronchi are discussed. The first had a gun shot wound of the anterior left chest with the bullet ricocheting across to the right hemithorax and puncturing the right mainstem bronchus resulting in right massive pneumothorax and subcutaneous emphysema. The second suffered a blunt thoracic trauma from a road traffic accident and presented with bilateral rib fractures and bilateral pneumothoraces treated with bilateral closed thoracostomy tube drainage. Bronchofiberscopy revealed complete transection of the left mainstem bronchus.

Spontaneous pneumothorax: A retrospective study of twenty-five patients and literature review.

We present a retrospective study of 25 patients with spontaneous pneumothorax (three current), comprising 16 Saudis (nine males and seven females) and nine non-Saudis (eight males and one female), seen at the Asir Central Hospital, Abha, over a period of 45 months. Almost one-third of the patients (9/25) had no underlying cause discernible by our investigational facilities (chest x-ray, ultrasonography, computed tomographic scan, and flexible bronchofiberscopy). Underlying pneumonia (three patients), pulmonary tuberculosis (two patients), lung abscess (one patient), and congenital bullae (one patient) constituted the etiology in another third of the spontaneous pneumothorax patients. Other underlying pulmonary diseases precipitating spontaneous pneumothorax in the group included pulmonary fibrosis, metastatic mesothelioma, and immunosuppression in a medulloblastoma patient undergoing chemotherapy with the development of chickenpox. Closed thoracostomy tube drainage was the only method of treatment in 20 out of the 25 patients, with three failures of closed thoracostomy tube drainage needing thoracotomy and resection of blebs/bullae. The only complication was empyema in two of the patients. Two patients were successfully treated conservatively with observation alone.

Deep venous thrombosis in Assir region of Saudi Arabia. Case-control study.

In a five-year case-control study (1988 to 1993) at Assir Central Hospital (ACH), Abha (8,000 feet above sea level), Saudi Arabia, 92 of 129 patients suspected of deep venous thrombosis (DVT) were studied with ascending contrast venography (CV) (74 patients, 80.4%) or Doppler ultrasonography (DUS) (18 patients, 19.6%). Female-to-male ratio was 2.3 to 1. Age range of patients was twelve to ninety years; mean age was 44.45 yrs +/- 17.38 years. DVT hospital incidence was 18 per 10,000 admissions. The most common associated factors included immobilization due to chronic diseases (21.7%), trauma and surgery (19.6%), and pregnancy and oral contraceptives usage (16.3%). The most common symptom and sign were limb pain and tenderness (95.6%). Limb swelling was noted in 93.5% of patients. The left lower limb was more commonly affected than the right. There was a definite increase of DVT during the winter months. Altitude was not a contributory factor. Pulmonary embolism was the greatest complication.

Thyroid malignancy in multinodular goitre and solitary nodule.

This is a retrospective study of 361 thyroid specimens during a 6 1/2-year period with the objective of investigating the prevalence and pattern of thyroid malignancy associated with multinodular goitre (MNG) and solitary nodule (SN). Fourteen of 172 MNG (8%) and 16 of 105 SN (15.2%) were associated with malignancy, a statistically insignificant difference (P = 0.06). Unlike in males, malignancy was significantly commoner in females with SN than those with MNG (P = 0.03) and generally occurred at a significantly older age (P < 0.05). On analysing thyroid carcinoma and lymphoma separately, patients with SN had a higher incidence of carcinoma compared with those with MNG (P = 0.01). It is concluded that surgical intervention may be the appropriate method of treating male patients presenting with MNG. However, in females, conservative management of MNG should be adopted unless surgery is indicated depending on clinical judgement and, if feasible, the result of fine needle aspiration biopsy.

Schistosomal appendicitis.

This is a retrospective study involving 4708 consecutive appendix specimens removed over a period of 6.5 years for a clinical diagnosis of acute appendicitis, 64 (1.3%) of which showed histological evidence of schistosomiasis. Thirty-four schistosomal appendicitis (SA) cases were compared with 68 non-schistosomal appendicitis (NSA) cases admitted during the same period. SA patients were older in age, usually of male sex, mostly Egyptians and tended to have a higher hemoglobin and a lower leukocyte count (P<0.05). Other features were not significantly different. It is concluded that, despite these differences, there are no reliable clinical or laboratory features by which SA can be predicted preoperatively. The majority of the studied patients were either discharged before the results of the histopathology study were ready and were lost to follow-up or the reports were overlooked. Therefore, we recommend that for all post-appendectomy patients living in or coming from endemic areas of schistosomiasis, the results of the histopathology study should be processed as early as possible and before the patient can be discharged so that the treatment can be commenced. Moreover, establishing a system by which infected patients could be traced and hence treated is highly recommended.

Colo-rectal carcinoma in a tropical African population: an overview report.

Fifty-one selected cases of colo-ano-rectal carcinoma seen in a tropical African population over a period of two decades were reviewed. The patients were divided into three groups. Group A were those cases seen under the age of thirty years, Group B were the resectable rectal carcinoma because they were bulky and occupied the whole of the pelvis. This we referred to as cases with "frozen" pelvis. Our modality of treatment consists of surgical excision when possible, the use of Levamisole, the use of 5-Fluoro-Uracil either intravenously, intraperitonealy and intrarectally as the case requires and radiotherapy when available. For Group A, the average survival period is 10.6 months, for Group B, it is 17.3 months and for Group C, it is 14.5 months. Symptoms of tenesmus and ascites improved by intrarectal and intraperitoneal infusion of calculated dose of 5-Fluoro-Uracil.

Infected abdominal aortic grafts.

Aortic grafts were inserted in 1711 patients at Ottawa Civic Hospital (OCH) between 1976 and 1986. Aorto-iliac occlusive disease was the indication in 884 while in 827, the graft was inserted for abdominal aortic aneurysms. Graft infection occurred in 12 patients; six presenting with gastrointestinal bleeding due to aorto-enteric fistula (AEF) and the other six presenting with groin abscesses, mostly as a draining sinus. These were treated with graft excision and immediate extra-anatomic bypass. Seven patients died, giving a mortality rate of 58%. Three surviving patients required above-knee amputatio. These results are comparable to the results of others in the literature; therefore, continuing assessment of all aspects of graft infection and the search for more effective methods of prevention and management are needed.

Topical ampicillin for prophylaxis against wound infection in acute appendicitis.

A total of 249 patients, undergoing appendectomy for acute appendicitis, were prospectively randomized into two groups. Group I, comprising 132 patients, received sterile normal saline irrigation to the surgical wound at closure. Alternatively, Group II included 117 patients, who received intraoperative topical ampicillin irrigation of the wound. Both groups were comparable with regard to age, sex, duration of symptoms, and severity of appendicitis. All patients additionally received preoperative systemic gentamicin and Flagyl. Wound infection occurred in 5.3% of Group I compared to only 0.9% of Group II (P<0.05). The reduction in infection rate was significant (P<0.05) in histologically proven appendicitis. We conclude that the addition of intraoperative topical ampicillin to systemic gentamicin and Flagyl augments prophylaxis against wound infection in acute appendicitis.