Acute appendicitis complicating pregnancy

Appendicitis occurring during pregnancy presents a difficult problem for both the treating gynecologist 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 mortality 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

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 during a 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 Ranson's factors present. Prognostic factors correctly predicted severity in 66% 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

Colorectal carcinoma: review of 110 cases

Over the 4-year period [1045 to 1408H], 110 cases of colorectal carcinoma were treated at Riyadh Central Hospital. The charts were reviewed with particular reference to the epidemiological characteristics. There were 59 [54%] Saudi patients with an average age of 51 years. Thirty-one percent of the patients were under 40. The male to female ratio was 2:1. The disease was found to involve the left side of the colon in 60% of the patients, while the right colons was involved in 35%. A curative resection was attempted in 38 [35%] patients. Mortality in the 77 patients who underwent surgery was 9%. It appears that colorectal carcinoma in the Saudi population affects a younger age group than that observed in the West, with a good percentage [35%] of right-sided colonic cancer. Because the familial non-polyposis from colonic cancer in this group of patients, we recommend that surveillance be directed to the respective families so that asymptomatic patients can be identified in an early stage of the disease

Laparotomy for abdominal injury in traffic accidents

This retrospective study presents an analysis of 178 road traffic accident victims on whom laparotomy was indicted. They accounted for 3.8% of total road traffic accident patients admitted to Riyadh Central Hospital during a 2-year period. One hundred seventy-two underwent surgery; the remaining six died in the admissions area before surgery. Male patients outnumbered female patients by a ratio of 8:1. Saudi comprised 56% of the victims. Diagnostic peritoneal lavage yielded an accuracy of 98% with no complications. Spleen [70 patients] and liver [69 patients] were the two most common injured organs. Overall mortality among the operated cases was 20.9%. Appeared to be directly related to the extent of injury to other systems involved

Road traffic accident fatalities in Riyadh Central Hospital 1400-1407H [1980-1987]

Trauma due to road traffic accidents [RTA[s]] in Riyadh has increased in direct proportion to the increasing number of cars. This study in an 8-year retrospective analysis of RTA fatalities at Riyadh Central Hospital [RCH]. During this 8 years, 64, 942 RTA victims attended RCH. Total RTA victims seen at RCH increased gradually with a steady decline in the number of deaths, which indicates improvement in care of RTA victims, both prior to arrival at the hospital and during hospitalization. At RCH, RTA is the primary cause of death for all age groups and especially for productive young adults below the age of 40 years

Is prophylactic antibiotic justified for routine cholecystectomy?

The routine use of prophylactic antibiotic in low risk cholecystectomised patients remains controversial. Two hundred patients were included in this prospective study, after exclusion of all identifiable risk factors. Half of them were randomly selected to be treated with antibiotics and the other half acted as controls and were not given any antibiotic. Only 2.5% of the patients needed exploration of the common bile duct. Bile culture was positive in 30.5%. The commonest organism isolated was E. coli. Eight out of the 200 patients developed wound infection, 5 from the antibiotic and 3 from the control group. As the high risk group of patients can be identified pre-operatively, routine use of antibiotic cover in low-risk patients is unnecessary