Radiological evaluation of patients after laparoscopic cholecystectomy

The objective of this study is to describe the normal, abdominal findings after laparoscopic cholecystectomy that could be confused with a pathological process. Thirty one patients, who had laparoscpic cholecystectomy were prospectively studied. They underwent supine and erect abdominal X rays, on the first and second postoperative days. In 19 patients [61%] no residual free intraperitoneal gas was seen. In 12 patients [39%] small amounts of free gas were noticed 24 hours postoperatively, and in six [19%] some free intraperitoneal gas was seen after 48 hours. Distention of the colon was noticed in 17 [55%], and was mainly in the hepatic flexure area in nine of these patients [29%]. Eight patients complained of shoulder pain. This study shows that pneumoperitoneum tends to disappear within 48 hours of laparoscopic cholecystectomy. When present, there is usually no cause for alarm as long as patients show no evidence of clinical disturbance

Hospital deaths at Asir central hospital

The objective of this study was to review the various causes of deaths in patients admitted to Asir Central Hospital over a 4-year period between 1st June 1991 [Muharram 1412H] and 31st May 1995 [D-Alhajjah 1415H]. The death certificates and death summaries of the patients who died at Asir Central Hospital, Abha over this 4-year period were reviewed with emphasis on the cause of death as agreed by the reviewing committee of 4 consultant doctors, from various specialties. When there was more than one diagnosis prior to death, the antecedent disease or injury which initiated the direct cause of death was listed as the cause of death. The coding system used for classification of mortalities was IDC-9. Of the total 1479 deaths recorded during this period of review, malignancy, trauma and cardiovascular disease ranked the first 3 groups of causes of death. Road traffic accident [14%] was the most common cause of death, followed by liver diseases [10%], cerebrovascular accident [9%] and cardiac diseases [7%]. Road traffic accident, a preventable situation, is the greatest killer in this environment. Liver diseases, malignancies and cardiac diseases are the other major killers. These findings are essential in proper allocation of resources for preventive, therapeutic and research projects to combat these killers

Colorectal carcinoma review of 63 cases at Asir central Hospital

This is a hospital-based retrospective study of 63 patients with colorectal cancer who were treated at Asir Central Hospital over a seven-year period. The incidence of colorectal carcinoma was found to be 2.34/100,000, and the prevalence was 16.36/100,000 population. The male to female ratio was 1.5:1 and the age of highest incidence was between 51 and 60 years. Saudi patients were affected at a later age when compared to non-Saudis [p < 0.01]. The most common symptoms were rectal bleeding, abdominal pain, and changes in bowel habits. The left side of the colon was involved more than the right side [67% versus 33%] [p < 0.03]. Most of the lesions were seen in Dukes B and C stages differentiated adenocarcinoma. Curative resection was possible in 68% of patients who underwent laparotomy. The post-operative mortality rate of patients who underwent laparotomy was 8%. The importance of rectal examination and rigid sigmoidoscopy is emphasised by the finding that 87% of rectal tumours were within the reach of the examining finger or the rigid sigmoidoscope

Topical ampicillin for prophylaxis against wound infection in acute appendicitis

A total of 249 patients, undergoing appendectomy for acute appendicitis, were prospectively randomized into two groups. Group I, comprising 132 patients, received sterile normal saline irrigation to the surgical wound at closure. Alternatively, Group II included 117 patients, who received intraoperative topical ampicillin irrigation of the wound. Both groups were comparable with regard to age, sex, duration of symptoms, and severity of appendicitis. All patients additionally received preoperative systemic gentamicin and Flagyl. Wound infection occurred in 5.3% of Group I compared to only 0.9% of Group II [P<0.05]. The reduction in infection rate was significant [P<0.05] in histologically proven appendicitis. We conclude that the addition of intraoperative topical ampicillin to systemic gentamicin and Flagyl augments prophylaxis against wound infection in acute appendicitis

Infected abdominal aortic grafts

Aortic grafts were inserted in 1711 patients at Ottawa Civic Hospital [OCH] between 1976 and 1986. Aorto-iliac occlusive disease was the indication in 884 while in 827, the graft was inserted for abdominal aortic aneurysms. Graft infection occurred in 12 patients; six presenting with gastrointestinal bleeding due to aorto-enteric fistula [AEF] and the other six presenting with groin abscesses, mostly as a draining sinus. These were treated with graft excision and immediate extra-anatomic bypass. Seven patients died, giving a mortality rate of 58%. Three surviving patients required above-knee amputation. These results are comparable to the results of others in the literature; therefore, continuing assessment of all aspects of graft infection and the search for more effective methods of prevention and management are needed