content of the undergraduate surgical course needs assessment

The College of Medicine, at King Khalid University [KKU], Abha, Kingdom of Saudi Arabia [KSA] has been trying to update its curriculum. The aim of this study was to determine the contents of the undergraduate surgical course. We adopted a questionnaire developed by the Association of Surgical Education [ASE], where responders graded the importance of 84 areas of knowledge and 46 skills. We sent the questionnaire to faculty members at KKU, consultants at Aseer Central Hospital [ACH], a group of students, house officers and residents in training at ACH. Knowledge and skills were ranked based on a mean value score [0-3] that determined the priority list. Stratification of results into three levels for knowledge; indepth-knowledge, moderate and familiarity. Skills levels were categories in three groups; proficiency, performed and observed. We compared our results to the finding of ASE published priority list. Our results showed that 25/29 of knowledge ranked as indepth-knowledge matched with ASE findings, whereas 4 topics received a lower score. Our responders added 8 topics that they found essential. Regarding skills priority score, our results matched in 22/24 of skills scored as proficiency essential by ASE. We concluded that the determination of surgery content for surgery course is essential to be done by the group of faculty members in the environment and region of the world were these courses will be implemented. Matching with international standards is important. We recommend that similar studies should be done prior to adopting international course

role of multi-detector computerized tomography in the evaluation and diagnosis of acute bowel ischemia

Acute bowel ischemia [ABI] is a complicated disorder that occurs when blood flow to the intestines is compromised. Multi-detector row CT combines multiple rows of detectors and faster gantry rotation with narrow collimation. Thus, it offers advantages over classic spiral CT for imaging the mesenteric vasculature and small bowel. The aim of this study was to evaluate the sensitivity and specificity of Multi-Detector Row Computerized Tomography technique in patients with suspected mesenteric ischemia. In this study, 72 consecutive patients were prospectively followed and examined at Aseer. Central Hospital [ACH] with clinical suspicion of ABI or having a CT diagnosis of ABI during the period between March 2003 and October 2004. CT scans were evaluated for evidence of criteria suggestive of ABI. Finally, CT findings and radiological diagnoses were compared to the final pathological diagnoses to measure its sensitivity, specificity, predictive value positive and negative predictive values. Acute bowel ischemia was documented in 56 patients. Their ages ranged between 23 and 85 years with the mean age is 62.5 +/- 15.5 years. Patients were divided to two groups [A and B]. From our study, combining the most sensitive and specific criteria; bowel wall thickening, mesenteric stranding, focal lack of bowel wall enhancement and ascities, increased the overall sensitivity of our technique and interpretation to 97% and the overall specificity to 100%. These finding should be considered in the management of acute bowel ischemia. The mortality rate in our study was 26.8% [15/56 patient] regarding patient proved to have ABI during laparotomy. We concluded that biphasic CT with mesenteric CT angiography is a valuable method of diagnosing ABI, with an overall sensitivity of97% and a specificity of 100%. Inspite of the advances and early intervention, the mortality rate of acute bowel ischemia is still high. Moreover, combining diagnostic criteria predicts high mortality rates

Drainge of pancreatic pseudocysts. the importance of cyst wall biopsy in the recent era

While open internal drainage has been the standard treatment for pancreatic pseudocysts, less invasive techniques which pay little attention to cyst wall biopsy, are becoming popular. The aim of this study is to report on our experience in draining pancreatic pseudocysts and probe the necessity or otherwise of obtaining a wall biopsy at drainage. Operation theatre registry, operation log books and medical records at Aseer Central Hospital, Abha, Kingdom of Saudi Arabia, were reviewed to retrieve the clinical details of patients with pancreatic pseudocyst who required a drainage procedure in a 13 years period from August 1989 to November 2002. Sixteen patients were identified. Cyst wall biopsy was obtained in 10 cases, in 8 of them the diagnosis was confirmed, while a true cyst was found in the remaining 2 excluding them from further analysis. In the remaining 14 cases [8 males, 6 females, mean age 38 years, range 4-60], pain was the main presenting feature. Open internal drainage was offered to 12 cases while one patient received external drainage under ultrasound guidance and the other received open external drainage. The type of operation was cystogastrostomy in 9 patients and cystojejunostomy in 3 patients. The recurrence rate after internal drainage was 16.7%, while after external drainage was 100%. There was no mortality in this series. A procedure-related complication occurred in 3 [21.4%] patients. The mortality, morbidity and recurrence rates in this series are compared favorably with other reports. The final diagnosis of a presumed pancreatic pseudocyst should rest on the histopathologic examination of the cyst wall

pattern of thyroid disease undergoing surgery in Kasr El Aini hospital during 1997

Diseases of the thyroid gland are common in our society. Moreover, it constitutes a significant percentage of our practice in the Department of Surgery, Kasr El Aini Hospital, Cairo University. Surgical procedures involving the thyroid gland accounts for about 6 percent of the operation list workload. In this study, we evaluated the pattern of thyroid disease managed in the Department of General Surgery. The diagnostic criteria, investigations, indications for surgery, surgical procedures and histopathological data were analyzed, tabulated and discussed. The study included 307 patients, admitted to the Hospital during 1997. The age range was 18 to 65 years with the mean of 38 +/- 11.4 years and 260[84.7%] of patients were females. Three hundred and seven thyroid operations were performed. Adenomatous goiter was the most common histological finding, it accounted for 61.2% of all specimens included in the study. Benign solitary thyroid pathology was found in 16.3% of the specimens examined and malignancy in 7.2% of the specimens examined. Thyrotoxicosis and Hashimoto's thyroiditis accounted for 13% and 2.3% respectively. Correlation of histological analysis and the type of operation suggested that a variety of operations were performed for the same pathological condition and that some operations were only diagnostic procedures. Forty-two thyroid Fine Needle Aspiration Cytology [FNAC] were performed to evaluate clinically suspicious lesions. From our study, we conclude that, malignancy accounted for a significant percentage among our patients. The role of thyroid function tests and radioactive thyroid scans are well established in our practice. The implementation of neck ultrasonography and FNAC in the management of thyroid disease in Kasr El Aini Hospital is increasing. The predictive values are in continuous improvement and coupled with the international standardized diagnostic protocols