Unrecognized foreign body in an elderly patient

Although aerodigestive foreign bodies are commonly seen in the paediatric age group, adults and elderly patients are not exempt from this problem. Respiratory tract foreign bodies are usually seen in extremes of ages and may not be discovered immediately, either due to the inability of the patients to express their symptoms, absence of protective airway reflexes or altered level of consciousness. A high index of suspicion is a must to discover and diagnose these cases. Here we report a unique case of a 68 year old man with a normal level of consciousness who was suffering from recurrent attacks of breathlessness [for almost 2 months] but who was treated as a case of bronchial asthma exacerbation because the patient was a known asthmatic. Following admission and investigation for stridor, his problem was found to be due to a foreign body lodged in the larynx

Morbidity patterns in study health problems for patients attending primary care clinics, King Faisal military hospital, Khamis Mushayt

To analyze morbidity patterns and rates for patients attending clinics affiliated to the Primary Health Care Department, King Faisal Military Hospital Khamis Mushayt. All patients [n=20745] who attended the primary health care clinics [n=10] during March 1992 were the subjects of the study. A special form was designed to collect daily data regarding age, sex, diagnosis, etc. Diseases were classified using the international classification of diseases, 9th revision [ICD-9]. Common conditions were defined in this study as diseases occurring in frequency of >/= 1.0% less common conditions >/= 0.5 - <1.0% and uncommon conditions >/= 0.1 - <0.5% of the total patients' visits. Nineteen diseases represented the most common conditions, 10 diseases represented the less common conditions and 31 diseases represented the uncommon conditions. Significant differences were found in the frequency of common conditions among males, females and children. This study provided data about common and less common health problems in primary health care clinics in certain Saudi communities. This data will provide a base for medical education and health service planning and for future comparison with other Saudi communities

Failure of plates in femoral shaft fractures

This study concluded that plate failure after femoral shaft fractures is an avoidable complication when some simple precautions are considered. Proper planning of the operative procedure is mandatory before applying it to the patient. This entails a thorough study of the fracture type and stability with a special consideration to its media cortex. It enables the surgeon to predetermine the length of the plate required and the direction of the screws used. A painstaking effort should be done in preserving the blood supply to the fracture fragments. Minimal periosteal and soft tissue stripping should be considered. Bone grafting should also be considered almost in every patient regardless of the type of fracture sustained. The question is whether this bone graft is to be only cancellous or a corticocancellous in the same time. The answer will always be in the medial cortex of the femoral shaft, it demands a cortical strut when comminuted. The patients should be closely followed up, and strict postoperative instructions should always be insisted upon regardless of their own circumstances

AO/plating of diaphyseal fractures in children

109 diaphysical fractures in 108 child, have been treated by open reduction and plate fixation using the ASIF/AO principles. There were 58 fracture femur, 31 forearm, and 20 leg bone fractures. Children were able to move early without external support, No infection was recorded. The child bone can tolerate compression without undergoing pressure necrosis. Stripping of the periosteum did not affect the blood supply and the healing process. The overall results were satisfactory in 97.2% of the cases. it is concluded that diaphyseal fractures in chilren as a rule can be treated closed, but open reduction and internal fixation was found to be of great benefit and should be done if the remaining deformities are liekely to result in significant functional loss