Thyrotoxicosis in Qatar

A retrospective study of 179 patients with thyrotoxicosis was undertaken to determine the cause of thyrotoxicosis in our hospital and the outcome of the three available treatment modalities for patients with hyperthyroid Graves' disease. Graves' disease was found in 84% of the patients, toxic multinodular goiter in 8.5%, toxic adenoma in 4%, and thyroiditis in 3.5%. Graves' disease affected women predominantly; the female to male ratio was 3:2, with mean age of 35 +/- 11 years. Ophthalmopathy was seen in 41% of the patients; goiter was absent in 8%. Most of the patients received antithyroid drugs as primary treatment. Forty-six patients with Graves' disease were seen in 1989; 89% had antithyroid drugs as primary treatment for a duration of 1 +/- 0.7 years, 68% relapsed. Of these relapsed patients, 82% were treated with radioiodine and 11% were treated with surgery In 105 patients with Graves' disease treated with radioiodine, 60% were cured; additional doses were needed in 19%; and hypothyroidism developed in 49% In 19 patients treated with surgery, 63% were cured; hypothyroidism developed in 16%; and permanent hypocalcemia developed in 5%

Methylprednisolone as a prophylactic drug aginst multiple organ failure [MOF] in severely injured patients

The objective of this retrospective and prospective study was to assess the prophylactic use of mega doses of Methyl prednisolone to prevent Multiple Organ Failure [MOF] after sever trauma. Review of all severely injured patients who were admitted from Accident and Emergency Department to SICU in Hamad G. Hospital and to surgical dept. in Al Zahraa University Hospital in the period between Jan 1997 to May 1998. Eighty five patients were included based on an injury severity score [I.S.S.] of at least 36. The diagnosis of MOF was based on Multiple Organ Failure scoring system [adapted from Goris et al. 1985]. All patients had received I.V. bolus dose of M.P. [30 mg/kg, body weight within first 6 hours after trauma]. Most of the patients were in the 3 rd decade of life with mean age of [33 years]. Male sex was predominant [90.6%] and the Qatari people followed by the Egyptians occupied the highest number involved in this study [30.6%], [14.1%]. Road Traffic Accident was the most common mechanism of injury [68.2%] followed by Fall from height [21.2%]. The head was the most commonly injured organ [72.9%], followed by the limbs [40.0%], the chest [36.5%], then the abdomen and pelvis. All patients were thoroughly investigated both biochemically and radiologically. CT and MRI as well when indicated. Some patients were submitted to Diagnostic Peritoneal lavage [15.1%] and Ultra sound for [9.6%], one patient exposed to angiographic embolisation. 37 patients [43.5%], had different surgical procedures, craniotomy, chest procedure, laparotomy and orthopedic operations. 7 patients developed MOF [8.2%], within the first week. 85 severely injured patients given Methylprednisolone were studied retrospectively and prospectively. 7 patients [8.2%] developed MOF. This reflect an encouraging result for the use of Methyl prednisolone as a prophylactic drug against MOF in severe trauma patients taking in consideration a high incidence at different centers who are not using Methylprednisolone

Primary tension - free epigastric hernioplasty: procedure and outcome

Between January 1992 and May 1998, we operated upon 110 patients with large epigastric hernias [3cms or more] performing a primary pure prosthetic tension-free repair using the onlay polypropylene mesh graft technique, aiming to reduce the expected high recurrence rate after other repairs [1,4]. This group is retrospectively reviewed. There were 77.3% females and 22.7% males. Only elective repairs were included. All recurrent cases, the pediatric age group and those with ascites were not included. 7 patients [6.4%] has other types of hernia while 13 [11.8%] had more than one epigastric hernia. 8 patients [7.3%] presented with diastases [divarication] of recti in addition to their hernias. No perioperative mortality. Removal of the mesh, mesh extrusion or deep mesh infection did not occur in any case. Recurrence rate was 2.7% [3 cases] and was attributed either to emergence of a new hernia [in 2 cases] or to a correctable technical error [in one case]. Total complication rate was 18% while, complication rate related to mesh application was 10.7%. All complications were not serious and easily controlled as they necessitated minor surgical reintervention in only 4.5% of cases. It is to be concluded that the results are gratifying and the technique used is simple, durable and has a few and easily treatable complications. So, we recommend this repair as the primary repair of all epigastric hernias 3 cm or more to reduce the high recurrence rates noticed with other repairs

Single stage repair of hypospedias by mustrade technique: experience in

Thirty patients having distal and mid penile hypo-spedias with chordee were operated upon during the period from January 1993 to May 1998 in Al Zahraa University hospital. Their ages ranged between 3 and 24 years. Mustarde technique was used in construction of the new urethra. This technique proved its efficacy in the repair of distal and mid penile hypospedias with chordee as a single stage repair without obvious complications

Laparoscopic inguinal herniorrhaphy

Remarkable success of laparoscopic cholecystectomy encourage the trials for laparscopic herniorrhaphy. Sevceral types of techniques were used. Our study followed the transabdominal pre peritoneal TAPP. A Prospective study for thirty five patients with 45 inguinal hernias under went TAPP. It was carried on from Jan. 1994 to May 1999, in Al-Zahraa University Hospital in Cairo and in Hamed G. Hospital in Doha Patients were selected without complications. Peak age incidence was between the fourth and fifth decades, with mean age 36 years. There were 6 cases direct and 39 indirect with five cases recurrent. All the patients were selected well and prepared properly preoperative. There were no operative complications, but post operative complications were infected wound and 2 recurrent cases who were treated by the open methods. Most of the patients were delivered on the same day. In conclusion TAPP is feasible and safe procedure for hernia repair with low recurrent rate and early convalescence

Incidence of carcinoma in multiple thyroid nodules and experience of surgical management

A retrospective study of thyroid carcinoma with emphasis on the incidence of carcinoma in multiple thyroid nodules and surgical management was carried out. The study covered a 12 years period from June 1986 to May 1998. Details of the cases were obtained from the records of the Surgical Notes, Medical Records Dept of AL-Zahrra university Hospital-Cairo. and Hamad G. Hospital-Doha. There was a total of 56 [9.1%] cases of carcinoma out of 616 surgically treated thyroid diseases. Females accounted for 45 and the males 11 cases giving a female to male ratio of4.1:1. The peak age incidence was between the third and fifth decades. Thirty three patients presented with single nodule [59%], 20 with multiple nodules [35%] and 3 diffuse, [5.3%] giving an overall incidence of malignancy in single and multiple thyroid nodules of 5.6% and 3.8% respectively from the 585 patients who presented with nodules. Thirteen patients [23%] presented with cerivcal lymphadenopathy. Most of the patients had a preoperative Ultrasound, T. Scan and general laboratory investigations. Firm diagnosis was made by one of these; FNA, frozen section or paraffin section. The following procedures were performed as the definitive treatment [i]; Hemithyroidectomy [27 cases] [ii] subtotal thyroidectomy [4 cases]; [iii] Near Total thyroidectomy [7 cases]; [v] Total thyroidectomy [17 cases]; One case was inoperable. Papillary carcinoma was the most common thyroid carcinoma [80.4%] and followed by follicular carcinoma [12.5%], medullary 5.3% and anaplastic carcinoma 1.8%. Of the 20 patients who presented with multiple nodules, there were 14 papillary, 3 follicular 2 medullary and one anaplastic carcinoma. No deaths were recorded amongst the papillary and follicular carcinoma cases, over a maximum of twelve years follow up. There was one death each in cases of medullary and anaplastic carcinoma. The incidence of 3.8% malignancy in patients with multiple thyroid nodules would war rant interventional rather conservative surgery. Near total or total thyroidectomy is the best choice as initial or completion surgery for all types of differentiated thyroid carcinoma. Hemithyroidctmy could be accepted in some cases