Clinical aspects and frequency of scorpion stings in the Riyadh Region of Saudi Arabia

To study the clinical aspects and frequency of scorpion stings in Riyadh region of Saudi Arabia. Clinical aspects and frequency of scorpion sting cases reporting to 2 referral hospitals in the Riyadh region of Saudi Arabia were analyzed during May 2006 to April 2008. Data on demographic status, date and time of sting, sting site, scorpion color, clinical manifestations, and treatment were collected. A total of 391 cases of scorpion stings were recorded from the 2-referral hospitals, 248 [63.4%] of were men and 143 [36.6%] were women. The 21-30 years age group was the worst affected, followed by 31-40 years, 11-20 years, and <10 years age groups. Larger number of stings occurred during the summer months, at nights, and on distal limbs. Most of the patients reached the hospital within one hour of the sting. The yellow scorpions were responsible for a larger number of stings than the black scorpions. Seventy-five percent of the patients showed local signs and symptoms and 25% demonstrated systemic manifestations of poisoning. Most of the patients were treated with antivenom. The high prevalence of scorpion stings largely with mild signs/symptoms and without any mortality suggests the predominance of weak venomous scorpion species in the Riyadh region. Therefore, the protocol of managing scorpion-sting patients with antivenom irrespective of the intensity of manifestations warrants a detailed review

Coronary sinus diverticulum as a cause of resistant posteroseptal pathway ablation

Coronary sinus [CS] anomalies such as diverticulum, persistent left superior vena cava or CS ostium dilatation are predominantly found in patients with accessory pathway-related tachycardias. Diverticulum of the proximal CS found in 7-11% of patients with postero-septal or left posterior manifests accessory pathways. We reported a 28 year old gentleman with manifested postero-septal accessory pathway, who underwent repeat electrophysiological study [EPS] and radiofrequency ablation for previously failed ablation. Huge CS diverticulum was identified by angiography as a reason for resistant accessory pathway. Successful RF ablation was achieved at the neck of the diverticulum without complications. Other associated anomalies were ruled out by cardiac computerized tomography [CT] and trans-esophageal echocardiography

Percutaneous, versus open epiphysiodesis

Epiphysiodesis is used for the treatment of leg-length discrepancy in skeletally immature patients. Phemister described an open technique that requires surgical dissection with potential morbidity. Recently, minimally invasive approaches that utilize intraoperative fluoroscopy have been introduced. The aim of this study is to compare our experience using the open and the minimally invasive percutaneous techniques. A prospective follow-up of 87 consecutive patients undergoing epiphysiodesis for correction of post traumatic leg-length discrepancy using either the open or the percutaneous technique at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia between January 1993 and December 2000. Out of the 87 patients, 52 were carried out using the open technique and 35 were utilized by this percutaneous technique. There was no statistically significant difference between the 2 groups in terms of demographic date, operative time, perioperative complications or time required to achieve the growth arrest. However, there was a significant difference in the hospital stay and postoperative need for physiotherapy. The percutaneous group had a shorter hospitalization [average 2.5 days] compared to the open technique group [average 4 days]. Our experience is similar to what is reported in the literature and confirms that the percutaneous technique has an advantage over the open technique with shorter hospitalization and less duration of physiotherapy

survey of patient's attitude toward low back surgery in a major center in Saudi Arabia

Similar to any other invasive procedure, low back surgery has potential complications. These potential complications lead many patients to refuse the surgery when it is indicated. The aim of this study was to evaluate patient's attitude toward low back surgery and identify factors that might influence their decision. Seventy consecutive patients who attended the outpatient clinic of the King Fahad National Guard Hospital Riyadh, Kingdom of Saudi Arabia, between May 2002 and July 2002, due to chronic low back problems and who were surgical candidates were included in this study. The low back outcome score [LBOS] was used to assess these patients. The proposed surgical procedure was explained to each patient and the family and the potential complications were discussed. The patient's response to the proposed surgery was assessed. Mantel-Haeuszel Chi-square test was used for statistical analysis. A total of 70 patients were included in this study. Thirty-eight were females and 32 were males. The average duration of symptoms was 3.3 years [range 0.5-20]. Of the whole group of 70 patients, 31 [44%] agreed to surgery. The remaining 39 [56%] refused surgery for various reasons. There was no statistically significant difference in the demographic data or the LBOS between the 2 groups. There is a relatively high refusal rate [56%] for low back surgery in the group studied. No specific influencing factor could be identified in this group. Pain and disability as measured by the LBOS does not seem to be a factor. Patient's education on the disease process and the contemplated surgery are crucial in helping them to make an informed and reasonable decision