One hundred and thirty seven living donor pediatric liver transplants at Riyadh Military Hospital. Results and outlook for future

To review the results of 137 living donor pediatric liver transplants performed at Riyadh Military Hospital [RMH]. Retrospective analysis of the in- and out-patient case notes was carried out. Data were collected regarding age, gender, nationality, diagnosis, type of procedure, complications and survival of the grafts and the recipients. The first 137 living donor pediatric liver transplants were performed in 113 months. The age range was 4.5 months to 14 years. Eighty-four recipients [61%] were male. One hundred and twelve children were Saudi. Left lateral segment was used as allograft in 135 cases. One child each received full left lobe and full right lobe. Six auxiliary partial orthotopic liver transplants were carried out. Familial metabolic liver disorders made the largest group of children needing transplant. The most common indications were progressive familial intrahepatic cholestasis and biliary atresia [45 cases each]. The numbers of major complications are: hepatic artery thrombosis [n=8]; portal vein thrombosis [n=3]; portal vein stenosis [n=3]; hepatic vein stenosis [n=3] and biliary strictures [n=4]. Fifteen patients died. Three further allografts have been lost. Thus, the overall patient survival rate is 89% and graft survival rate is 86.8%. Living donor liver transplantation is a viable option for children with end-stage liver disease. Metabolic liver disease is the most common indication in Saudi Arabia. The cadaveric donor supply is in shortage and living donation is a practical alternative. The incidence of complications and recipient and graft survival rates of the program at RMH are acceptable

Castleman disease presenting as obstructive jaundice

A 48-year-old Saudi male was admitted with features of obstructive jaundice. Endoscopic retrograde cholangiopancreatography showed stricture in distal common bile duct CBD. Computed tomography scan revealed lymphadenopathy along CBD and in porta hepatis. Cholangiocarcinoma, lymphoma or metastatic deposits were suspected but no definite preoperative diagnosis could be established. Laparotomy disclosed lymph node enlargement in porta hepatis and along the CBD and lesser curvature of the stomach. Triple bypass procedure was performed to relieve the obstruction. Pathological examination of the lymph nodes showed Castleman disease of hyaline vascular type

Laparoscopic cholecystectomy for acute cholecytitis. Can preoperative factors predict conversion?

To determine if preoperative clinical, laboratory and radiology data can predict conversion of laparoscopic cholecystectomy for acute cholecystitis to open procedure. Retrospective analysis of 44 laparoscopic cholecystectomies were performed for acute cholecystitis between August 2000 and July 2002 at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. Data related to age and sex of patients, maximum body temperature, white blood cell count, gallbladder wall thickness on ultrasonography and timing of surgery from onset of symptoms were collected. The procedure was converted from laparoscopic to open cholecystectomy in 10 patients [23%]. Conversion rate was significantly high [33% versus zero; p=0.01] if the gallbladder wall was thickened. Conversion rate was significantly low [zero versus 32%: p=0.01] if the procedure was performed within 48 hours from the onset of symptoms. The data related to age, sex, white blood cell count and body temperature did not reliably predict conversion of laparoscopic cholecystectomy for acute cholecystitis to open procedure. There was no mortality or major morbidity. Laparoscopic cholecystectomy is a safe modality of treatment for acute cholecystitis. Factors associated with increased conversion rate are thickened gallbladder wall on ultrasonography and delay in surgery for more than 48 hours from the onset of symptoms

Quality of drinking water in rural areas

A total of 106 water samples from various sources of drinking water in villages around the University campus, were taken for bacteriological examination. A topographical examination was also carried out and recorded in a proforma. The results of the study show that water from open wells and earthenware pitchers [used as storage containers] was grossly contaminated with Escherichia coli and Streptococcus faecalis. The samples taken from tubewelis [through taps] and hand-pumped wells were also contaminated, but to a lesser degree. The surrounding of the water sources were unhygienic and therefore faecal contamination was liable to occur continuously