comparative study of laparoscopic versus open appendectomy

Laparoscopic appendectomy has gained popularity in recent years and has become one of the most widely performed procedures. However, it is not the universal gold standard as laparoscopic cholecystectomy for acute cholecystitis. This is, perhaps, due to the emergency nature of disease often operated by junior staff in odd hours when laparoscopic equipment, trained staff and supervision may not be available. To compare the results of open with laparoscopic appendectomy in terms of postoperative pain, rate of wound infection and hospital stay. This study was conducted in Al- Kadhmyia teaching hospital, over a period of six months from the 1[st] of October 2009 to the 1[st] of April 2010. Patients undergoing surgery for acute appendicitis were randomly assigned into one of the two groups [A or B] after obtaining written and informed consent. In Group-A patients underwent open appendectomy and in Group B laparoscopic appendectomy was performed. Post operatively pain chart, days of hospital stay and wound infection was recorded. Sixty patients [38 male, 22 female], with clinical diagnosis of acute appendicitis based on Alvarado score of six and above, were included in the study. They were randomized into 2 groups of A and B with 30 patients in each group. Group-A comprised open appendectomy procedure and Group-B comprised laparoscopic appendectomy. Comparison of postoperative pain by visual analogue scale was significantly low in Group B, compared with Group A, on day 0, 1 and 2. Number of days in Hospital was 4.1 +/- 0.8 days in Group A and 1.5 +/- 0.06 days in Group B. None of the patients in Group B, while 8 [26.67%] patients in-Group A, developed postoperative wound infection at 1 week follow up. Laparoscopic appendectomy is safe and effective. Postoperative pain, hospital stay and wound infection were significantly lower after this mode of surgery

Central nervous system tuberculosis and adjuvant corticosteroid therapy.

Tuberculous involvement of central nervous system is one of the important health issues causing high mortality and morbidity. Uncertainty and doubt dominate all aspects of CNS tuberculosis. Diagnosis is mainly based on clinical features, cerebrospinal fluid changes, and imaging characteristics. Few studies have shown that corticosteroids improve the clinical outcome, although the precise mechanism of action remains tentative. All the cases were selected on strong clinical suspicion of CNS tuberculosis. They were graded according to tuberculous meningitis (TM) severity grades. In this connection, we studied 13 patients in one medicine unit over 12 month's period to see the effect of corticosteroid as part of the outcome. Nine patients (69.23%) were in grade II, three (23.08%) patients were in grade III, and one (7.69%) was in grade I. Seven patients (53.85%) had tuberculous meningitis and six (46.15%) had tuberculoma (CT or MRI). Out of 13 cases 3 patients (23%) died in the hospital and 10 patients (77%) improved, of whom 2 patients (20%) recovered completely and 8 patients (80%) had residual neurological deficit. Our study suggests that the early detection of CNS tuberculosis is the most important prognostic factor. Timely started anti-Koch's treatment with adjuvant corticosteroid therapy has a direct bearing on patient outcome.

Retrospective analysis of 1206 maxillofacial fractures in an urban saudi hospital: 8 year review

This is a retrospective review of fractures of the facial skeleton admitted at Riyadh Armed Forces Hospital, Oral and Maxillofacial Plastic Surgery unit over an 8-year period. This study encompassed a total of 1206 fractures found in 986 patients. Of these, 84% were males and 16% females, of which 69% were young in the age group 20-39 years. Other variables considered in this study included the aetiology, fracture location, associated injuries, hospital stay and complications. The single major causative factor of facial trauma was found to be road traffic accidents [RTA's] and were associated with head and ocular injuries in a high percentage. There is a great need to educate the public on the dangers of imprudent recreational use of vehicles