Left ventricular function after mitral valve repair versus mitral valve replacement with chordal preservation: a comparative prospective study

This study included 26 patients. Two patients died during the postoperative period, 4 were lost for follow up and complete follow up data are available for the 20 patients. Patients were randomized preoperatively into two groups: Group A included 12 patients with mitral valve repair and group B included 8 patients with mitral valve replacement with chordal preservation. All patients had severe chronic mitral incompetence. The age of these patients ranged from 12 to 38 years [mean +/- SD 23.2 +/- 8.3 years]. Four patients were males and the remaining 16 patients were females. Echo was used to estimate left ventricular dimensions, percentage fractional shortening, ejection fraction, end systolic stress and the ratio between it and end systolic volume index. Ring annuloplasty using Carpentier ring was used in all repair patients and the posterior leaflet and its chordae was preserved in all patients with mitral valve replacement. The duration of stay in ICU, cardiopulmonary bypass time, the anoxic time, need for inotropic support, time to extubation, presence of residual incompetence and the functional class after. From the results, it was concluded that left ventricular function is prone to deterioration after both mitral valve repair and replacement. Deterioration in left ventricular function was more pronounced after mitral valve replacement with chordal preservation rather than mitral valve repair. Disruption of the papillary mitral loop is the most plausible explanation for the worse left ventricular function after mitral valve replacement with chordal preservation

Role of chest wall irradiation in T2 breast cancer cases following mastectomy

This prospective study included 204 breast cancer cases with PT2 primary tumors out of 802 breast cancer cases who attended at NEMROCK over 3-year period [1993-1995]. Patients with PT2 tumors did not receive chest wall irradiation after radical or modified radical mastectomy irrespective of any risk factor according to breast unit protocol adopted in NEMROCK. The overall recurrence rate was 10.29%, a multivariate analysis was done to identify the significant predictors influencing chest wall recurrence concluded that +ve axillary lymph nodes, high tumors grade and inner quadrant site in age <35 years are significant predictors of chest wall recurrence in patients with PT2 breast cancer cases that require postoperative chest wall irradiation according to this study

Quilting of mucoperichondrial flaps following septoplasty, an alternative to nasal packing

To find out a simple and effective method to stop haemorrhage and prevent haematoma formation after nasal septal surgery. DESIGN: prospective clinical trial. SETTING: Bahawal Victoria Hospital ENT department. PERIOD: Two years during 1993 - 1994 inclusive. SUBJECTS: 80 patients with deflected nasal septam admitted for surgery [70 males and 10 females] Male: female ratio 7:1. METHOD: Quilting of the mucoperichondrial flaps. None of the patients had either haemorrhage or haematoma. The surgical technique is simple, safe and effective

Clinical and laboratory profile of episodes of diabetic ketoacidosis in Madina Al-Munawarah, Saudi Arabia

Although the precipitating factors and mortality has been previously studied, there is no report of clinical and biochemical profile of patients with Diabetic Ketoacidosis in Saudi Arabia. To study the clinical and laboratory profile of patients with diabetic ketoacidosis in Madinah Al-Munawarah, Saudi Arabia. King Abdul Aziz and Fahad Hospital Madinah-Al-Munawarah Saudi Arabia. May 1991 to April 1992. 85 consecutive admissions among adults =/>age 12 years. Criteria for diagnosis of diabetic ketoacidosis was arterial pH>7.3, serum bicarbonate <15 m mol/l, hyperglycaemia with blood sugar >12.1 m mol/l. Other causes of metabolic acidosis excluded. Clinical features and results of laboratory profile were noted at the time of hospital admission. Laboratory profile included: blood sugar, arterial pH, arterial bicarbonate, serum urea, serum Na+and K+ with calculated serum osmolality. Commonest clinical features included, nausea and vomiting [48%], polyuria and polydipsia[46%], abdominal pain[33%] and dizziness [21%]. Unconsciousness [11%] was a rare presentation. Mean laboratory profile of these cases included, blood sugar 33.9 m. mol/l, arterial pH 7.10, bicarbonate 6.8 m.mol/l, serum urea 9.2, serum Na+ 132 m.mol/l, serum K+ 4.4 m.mol/l and calculated serum osmolality of 317 m.Osmol/l, Our study indicates that nausea, vomiting and abdominal pain are more common in diabetic ketoacidosis patients in Saudi Arabia while the laboratory profile is generally in agreement with other studies in Asia

Vascular injuries of the neck a prospective study of 36 patients

To evaluate the proper role of clinical examination alone in the diagnosis of vascular injury of the neck in a less equipped hospital. Design: Thirty six patients with vascular injuries to the neck, admitted during 1982-96 were prospectively studied. Setting: Diseases Department of Cardiovascular Surgery, the National Institute Cardiovascular [NICVD], Dhaka, Bangladesh. Patients: Thirty six patients admitted with vascular injury to the neck were studied. Main outcome measures: Incidence of vascular injury to the neck, patients undergoing neck exploration on the basis of clinical evaluation alone. Stab wounds constituted more than 66% of vascular injuries in the neck. Out of total 36 patients 16 had carotid artery and 20 had external or internal jugular vein injuries. Lateral suture repair of 20 vessels and end to end anastomosis of 12 vessels were performed without perioperative neurologic deficit. Four cases of common carotid artery [CCA] pseudoaneurysms undergone aneurysmectomy and end to end anastomosis or vein patch repair while on one patient with A-V fistula between CCA and internal jugular vein, ligation and excision of the fistula and Dacron patch repair of the arterial wall defect was performed. Conclusions; The correct decision of neck exploration for suspected vascular injuries can be taken on clinical findings alone while advanced diagnostic facilities are either lacking or absent. Based on our findings routine use of angiagrophy in penetrating neck injuries is probably not justified

Metronidazole-resistant Helicobacter pylori strains among Saudi patients with dyspepsia

To determine how common are metronidazole-resistant [MTZ-R] Helicobacter pylori [H.pylori] strains in Saudi patients. A prospective study in patients with dyspepsia attending for gastroscopy at Asir Central Hospital, Abha, Saudi Arabia. Each biopsy specimen was inoculated on a Skirrow's selective medium and incubated at 37 °C under a microaerophilic atmosphere for 3 to 7 days. Suspected colonies were tested further for identification and susceptibility testing. A total of 40 different H.pylori strains were studied. Of the 40 strains isolated, 16 [40.0%] were MTZ-R. Females showed a higher, though not significant, rate of MTZ-R [47%] than males [33%] [p=0.37]. Furthermore, patients with MTZ-R strains showed lower median age [35 years], compared to those with susceptible ones [45 years]. However, the difference was not significant [t=1.89, p=0.07]. Moreover, MTZ-R was not significantly affected by the type of endoscopic diagnosis [duodenal ulcer [30%] and gastritis [50%], p=0.20]. Since MTZ-R H.pylori strains are frequent [40%], it is recommended to test MTZ susceptibility if possible before treatment, to guide the selection of appropriate therapy and to avoid eradication failure, in particular patients with a history of H.pylori treatment failure. Metronidazole resistance was not affected by age, sex or diagnosis

Efficacy of metronidazole-based triple therapy on eradicating HPylori positive peptic ulcers in mainly Saudi patients

To evaluate the short-term efficacy of triple antibiotics on eradicating H.pylori from peptic ulcer patients. Design: Prospective study. Peptic ulcer patients of both sexes were included if they were H. pylori positive on culture and/or histology and were aged between between 18-75 years. Patients were excluded if they had severe coagulopathy, if the females were pregnant and if antibiotics or non-sterioidal anti-inflammatory drugs had been recently used. All patients received a combination of metronidazole 500 mg PO t.i.d., amoxicillin 500 mg PO q.i.d., both for 2 weeks and bismuth subcitrate colloidal 120 mg PO q.i.d. for 4 weeks, in addition to ranitidine 300 mg PO at night for 6 weeks. Eradication of H.pylori was defined as absence of the organism in both histology and culture 6 weeks after completing triple therapy. H.pylori susceptibility was performed using the disc diffusion method. Forty-nine patients; 38 males, mean age 41.4 years and 11 females, mean age 40.3years were included. Eighty-four percent of peptic ulcers had healed by the end of the study period. However, only 49% of H.pylori was successfully eradicated. Overall metronidazole resistance was encountered in 45.7% of H.pylori isolate. Females harbored resistant strains more frequently than males, 77.8% versus 34.6%, respectively [p=0.03]. Metronidazole based triple therapy has a low success rate which is most likely secondary to H.pylori resistance

Deliberate non-fatal self harm in patients attending a general hospital in Saudi Arabia

Though deliberate non-fatal self-harm [DSH] has become a rather common form of nonverbal communication in Western Countries, the impression from the developing countries has been one of being very rare. Arabic countries are among the ones with the lowest reported rates. Our aim in this study is to investigate the patterns of DSH in Saudia Arabia an Arabic country with a strong religious background. All patients attending the largest general hospital in Jeddah City, with a recognisable self-harm behaviour, were prospectively assessed by the psychiatrist. Their characteristic features and clinical data were analysed using chi square for any significant statistical differences. Only 55 patients were referred in a period of 9 months with a diagnosis of DSH, 45 females [81.8%] and only 10 males [18.2%]. Males were older than females and non-Saudis were significantly more older and presented with more serious high suicidal risk DSH behaviours. Though DSH rates in Arabic countries may still be considerably low, in comparison to those reported from the western countries, the current indications is that many of these countries may witness a considerable increase, unless they maintain their strong religious affiliations and emphasise the importance of preserving their traditional family structure

Cleft lip and palate in children of Baghdad's Al-Resafa schools

In a prospective study, the first author has surveyed 61 schools [17 nursery school and 44 primary school] in Baghdad-Alresafa side. Our study has involved the examination of 24250 students find the incidence of cleft lip and palate in those children. 30 students were found to have cleft lip and/or palate giving an incidence of about 1:808 or 1.237 per 1000. Isolated clef palate was more common than cleft lip with/without cleft palate. The fifth and second grades have the highest percentage. Males were predominated for all types, and the left side was involved more than the right side with bilateral cleft lip occupying an intermediate position

Preventable forms of severe mental retardation

To study the cause-prevention of mental retardation. 70 cases were studied prospectively a Al-Mansoor Paediatric Teaching Hospital/Saddam's Medical city/Baghdad, from October 1989 to April 1990. The study showed that a definite cause behind mental retardation was found in 46 [65.7%] cases. Possible cases were found in 7 [10%] cases, whereas in 17 [24.3%] cases the definite causes were unknown. The study showed that a good proportion of cases might be due to causes amenable to prevention and with special possible measures, numbers of mentally retarded patients can be reduced in our community

Classification and immunophenotyping of acute leukemias: a prospective study

Over a period of 3-1/2 years, 86 cases of acute leukemia were analyzed by immunohistochemical [IHC] means on ficoll separated cytospin preparations of peripheral blood and/or bone marrow samples. Antibodies included in the panel were specific against Tdt, HLA-DR, CD19/CD20/CD22, CALLA [CD10], CD2, CD11C as well as against Ig heavy chains. Of 86 cases analyzed, 48 cases were of ALL, [25 of common pre-B ALL, 15 of pre-B/NULL and 8 of T ALL phenotype], twenty-four [24] out of 86 cases were of non-lymphoblastic [AML/AMML] type. In six cases, there was suggestion of a mixed lineage, while in 8 cases there was inconclusive diagnosis. Mean age was lower in common ALL sub-set of ALL as compared to pre-B/NULL group [i.e., 8 vs 12 years], while in non-lymphoblastic group it was 36 years. T cell phenotype was invariably seen in young adults, who usually presented with a mediastinal mass

Bone marrow involvement in Hodgkin's disease: the significance of non-infiltrative changes

We have tried to elucidate the significance of so called non-infiltrative changes in order to find their place in the staging procedure particularly in countries where facilities for elaborate clinical staging are not available. Seventy nine out of 88 patients were classified into 3 groups depending upon the histological findings in their bone marrow trephine biopsies. Bone marrow in Group-I [n = 20] patients was essentially normal. The established criteria of bone marrow involvement were fulfilled in Group III patients [n = 25]; while bone marrow in Group-II patients [n = 34] showed non-infiltrative changes. The clinical presentation, peripheral blood parameters and LDH levels of the 3 groups of patients were compared. There was progressive anaemia, neutrophilic leucocytosis and increase in ESR from Group I to III. The change was statistically significant when Group I was compared with Group II or Group III but non-significant when Group II was compared with Group III. It is, therefore, postulated that both Groups II and III reflect the bone marrow involvement although the changes observed in Group II do not satisfy the previously established criteria for this purpose

Older maternal age and pregnancy outcome

A prospective study of 357 pregnancy women 35 uears older who were delivered at Baghdad Teaching Hospital from August 1,1993, to June 30, 1994 was undertaken. Pregnancy was compared with a control group of 380 women whose ages were 20-29 years at delivery. There was a significant increase in the incidence of the following complications: hypertension, diabetes, varicose veins, pretem delivery and post partum haemorrhage. The incidence of operative deliveries was increased in old pregnant women compared to the control group. Infants of older women had a significant increase in macrosomia, low birth weight, low Apgar scores, anomalies and perinatal death. Pohysicians caring for older pregnant women must be aware of the risks in order to provide comprehensive medical and obstetrical care

Fetal echocardiography: in utero acoustic window on the developing heart

The purpose of this study is to evaluate prospectively the accuracy of fetal echocardiography performed at a tertiary referral center [Aramco Dhahran Health Center] in defining the exact anatomic features of various cardiac lesions in fetuses with congenital heart disease. Fetal echocardiography has been used to plan the appropriate course of care for high-risk pregnancies and in the immediate neonatal period. This includes a team of obstetrician, radiologist, pediatric cardiologist, and neonatologist. A sample of 65 consecutive fetal echocardiograms and their matching neonatal echo/Doppler studies were compared. The referral sequence was initiated by the obstetrician to the radiologist, then to the pediatric cardiologist, and the neonatologist. Four groups of fetuses/neonates were identified in this study based on their fetal cardiac examination: [1] normal cardiac anatomy and performance [n = 30]: none had any significant cardiac lesion on postnatal echocardiogram; [2] fetal arrhythmia [n = 12]: premature atrial beats and bigeminy were found in 9 fetuses and disappeared in the immediate neonatal period. Atrial tachycardia [atrial rate 400's - ventricular rate 200's] was seen in 3 fetuses and required maternal and neonatal treatment with digoxin in one; [3] nonimmune hydrops fetalis was diagnosed in 8 fetuses: it was mild and resolved in 7 patients shortly after birth. One fetus died in utero with severe hydrops; and [4] complex congenital cardiac lesions were found in 11 fetuses [18%]. Some minor anatomic findings could not be defined prenatally in 7 of them. Four cases were excluded due to lack of correlation between pre- and postnatal studies. We conclude that [1] fetal echocardiography, as an intimate part of a comprehensive fetal assessment, is highly sensitive and specific in detecting congenital heart disease in the fetuses; [2] appropriate management of high-risk pregnancies and neonates can be significantly improved when the exact pathophysiology of the unborn fetus is known by fetal echo/Doppler; and [3] fetal echocardiography is extremely safe and reliable throughout the three trimesters