Comparison of neurological outcomes in patients undergoing conventional coronary artery bypass grafting, on-pump beating heart coronary bypass, and off-pump coronary bypass

To study the differences in the prevalence of neurological complications following coronary artery bypass [CAB] carried out by conventional, on-pump beating and off-pump techniques. A retrospective analysis of all isolated coronary bypass operations [n=127] performed in King Fahad Cardiac Center, Riyadh over a period of one year starting from January 2005. Out of 127 patients, 73 underwent conventional CAB graft [CABG], 33 patents on-pump beating heart coronary bypass, and 21 had off pump coronary bypass grafting [OPCAB]. All patients had preoperative carotid scans and those who developed neurological complications underwent CT-brain and expert neuro-psychiatric assessment. Preoperative characteristics of patients in all 3 groups were similar. The bypass times in the conventional CABG group were significantly longer than the on-pump beating group. The maximum number of grafts was in the on-pump beating group, followed by the conventional CABG, and the least in the OPCAB group. Seven out of 73 cases in the conventional bypass group developed neurological events of various severities. Only one out of 33 patients developed acute confusional state in the on-pump beating group and no neurological events were noticed in 21 patients operated by the OPCAB technique. Low ejection fraction, preoperative congestive cardiac failure, non-elective surgery and preoperative catastrophic state were found to be significant risk factors independent of the bypass technique. This study shows no significant difference in the prevalence of neurological complications among different types of bypass surgery in our institution. There was a trend towards less neurological outcomes in the OPCAB and on-pump beating groups

Graduate education in surgery in the Kingdom of Saudi Arabia. the challenge of growing pains

With the establishment of undergraduate medical education and the progress of health care in the country heralded by the return of well trained and dedicated physicians and surgeons, it was only natural that the attention will be focused on establishing graduate training for the different medical specialties in the Kingdom of Saudi Arabia. This paper addresses the current status of general surgery training in the country and compares our model with the experience of others from the perspective of a program director. It is not the exception, but it is the rule to have challenges at this stage of development. The problems are multifactorial and need to be addressed by all those concerned with an open mind. I pretend no special farsightedness and my authority rests only on genuine concern about the issues and experience from being both a surgeon and a program director. The aim is of course to produce a future generation of well trained surgeons able to meet the challenge and take the lead in the medical care of this country. Once sound general surgery training is in place, training in specialty surgery such as thoracic and cardiac to name a few will follow suit

Medical liability. the dilemma of litigations

all of the physicians are ill prepared when it comes to facing a medical litigation. Having witnessed that first hand on numerous occasions made me decide to write on this issue to offer some insight and advice on the matter as it is obvious no one is immune in the medical profession. In addition, the number of medical litigation cases is on the rise. There is no doubt that the matter is of great importance not only to doctors, medical and dental students but also to other health care workers. The data of the cases submitted to the Medico-legal committee of the Ministry of Health, Riyadh, Kingdom of Saudi Arabia from various parts of the country for the period 1420 through to 1423 H [1999-2003] were examined and analyzed. A total of 2223 cases were referred to the various committees over the past 4-years for considerations. Obstetrics lead the way in being the most litigation prone medical specialty. Surgery takes the second place followed by internal medicine pediatrics being the fourth in order of frequency. The other specialties are some where in between. Least number of malpractice lawsuits were filed against the dental profession. Litigations can not be totally prevented but it could be limited to only the legitimate ones