Aggressive strategic planning for oral health in Kuwait: a decade of post-war successes.

Strategic planning and implementation of oral health care and disease prevention programmes after the 1990/91 Gulf war are discussed. The key concept was to develop access to care and disease prevention for all Kuwaiti children in government kindergarten/primary schools and to eliminate emphasis on extractions and restorations. Resources were restored to pre-war levels and then increased. Prevention programmes for 150 000 children were established. Prevention funds increased from 7% to 20% of the oral health budget. Prevention-based dentists increased from 9.7% to 28.0% of staff. Rising caries trends were stabilized or reduced by up to 36.8%. Percentage of caries-free primary dentition in children increased up to 37.6%, permanent dentition up to 27.0%. A dentistry school was established.

Aggressive strategic planning for oral health in Kuwait: a decade of post-war successes

Strategic planning and implementation of oral health care and disease prevention programmes after the 1990/91 Gulf war are discussed. The key concept was to develop access to care and disease prevention for all Kuwaiti children in government kindergarten/primary schools and to eliminate emphasis on extractions and restorations. Resources were restored to pre-war levels and then increased. Prevention programmes for 150 000 children were established. Prevention funds increased from 7% to 20% of the oral health budget. Prevention-based dentists increased from 9.7% to 28.0% of staff. Rising caries trends were stabilized or reduced by up to 36.8%. Percentage of caries-free primary dentition in children increased up to 37.6%, permanent dentition up to 27.0%. A dentistry school was established

Community based schoolchildren's oral health programmes, Kuwait 1985--1998.

AIM: To describe the development of children's oral health programmes in Kuwait and present selected results and expected outcomes based on specific markers. To provide a basis for choosing best outcomes to develop public health policy and implement future programmes. METHOD: Assessment of the health, structural, cost and benefit changes in the oral health sector that resulted from policy decisions and implementation through different approaches in the period 1986--1998. RESULTS: Analysis has provided a basis for selection of appropriate methodologies to be implemented in the country. CONCLUSIONS: The regional programme consisting of full immediate prevention coverage with fluoride lozenges, periodic fluoride rinses, multi-operator care teams, flexible and moveable equipment appears to have provided the best potential within the Kuwait context during this period.

[Cystic lymphangiomas of the mesentery and the epiploon. About two cases]. / Le lymphangiome kystique du mésentère et de l'épiploon. A propos de deux cas.

Two cases of cystic lymphangiomas of the mesentery and the epiploon are hereby related. The authors underline the following points: first, the rarity of these tumors along with the absence of significant clinical features makes the differential diagnosis with ovary tumors a difficult task. Second, although abdominal ultra sonography, completed by CT scan, allows the hypothesis of lymphangioma, only histological examination will confirm the diagnosis. There is no other treatment but complete exeresis, with a good prognosis and exceptional recurrences.

Caries experience in a selected group of children in Kuwait.

A study to set base-line data for future interventions to develop young children's oral health care was carried out in November 1993 in Kuwait. The study population comprised a random sample of 450 3- to 7-year-old children drawn from the students in Kindergarten and Primary Departments of Kuwait English School in the Salwa District of Kuwait. The mean dmft and mean d values were highest at the age of 6 (4.1, SD = 3.6, and 2.1, SD = 2.4, respectively) and lowest at the age of 4 (1.4, SD = 2.5, and 1.0, SD = 2.0, respectively). The proportion of caries-free children (dmft = 0) was 39%. Molars and maxillary incisors were most prevalently affected by caries. There seems to be a distinct need for both organized dental health care and preventive programs for the very young children in Kuwait.

[Cancer of the breast in men. Apropos of 50 cases]. / Cancer du sein chez l'homme. A propos de 50 observations.

Breast cancer, rarely encountered in men, accounts for 0.2 to 1.5% of the cancer morbidity in men and 1 to 5.7% of all breast cancers. The aim of this work is to analyse the different epidemiological, therapeutic and outcome features of this disease in men using a retrospective multicentric approach to 50 cases reported in Casablanca from 1980 to 1992. The mean age of the patients was 60.6 years. No significant risk factor was found. The mean delay to consultation was 22.5 months. Diagnosis was made at an advanced stage as, the tumour was located behind the nipple in 98% of the cases and ulcerated in 52%. Laterality was almost identical. Invasive galactophoric adenocarcinoma was found in 86% of the cases. Treatment was usually Patey mastectomy with positive nodes in 84%. Complementary treatment included radiotherapy in 60%, chemotherapy in 36% and hormonotherapy in 1 case. Recurrence was observed in 71% of the patients who has achieved complete remission. Surviceal in evaluable cases was 59 and 25% at 2 and 5 years respectively. The results in this series was less satisfactory that it is generally reported in the literature which suggests the need for better codification and management.

[Therapeutic approach in a case of papillary cancer of the thyroid gland. Apropos of 22 cases]. / Notre attitude thérapeutique devant un cancer papillaire pur de la thyroïde. A propos de 22 cas.

The authors report about a series of 22 papillary carcinomas of the thyroid gland. Among the operated patients, 6 underwent loboisthmectomy, 9 total thyroidectomy. For papillary carcinoma, a frequent cancer (1.3% of all cancers) dominating in women, the survival rate is virtually the same if the lesion is treated with maximal or conservative surgery. The results obtained with minimalist conservative procedures (decrease in morbidity, no recurrence) reinforces the authors' attitude, even more so as it corresponds to the data found in the literature.

[Primary leiomyosarcoma of the left renal vein]. / Léiomyosarcome primitif de la veine rénale gauche.

The authors report a case of leiomyosarcoma of the left renal vein. Because of its retroperitoneal position, this exceptional tumour was responsible for few symptoms. Complementary investigations (CT scan, ultrasonography, arteriography) often do not confirm the diagnosis. Complete surgical excision combined with complementary treatment can ensure long-term survival.

[Subcapsular hematoma of the liver, a complication of pregnancy toxemia]. / L'hématome sous-capsulaire du foie, complication de la toxémie gravidique.

The authors report three cases of subcapsular liver hematomas occurring after delivery and diagnosed by ultrasonography (1 case), and exploratory laparotomy (2 cases). These three cases compared with the data from the literature, illustrate the conditions of occurrence and the clinical signs of subcapsular liver hematomas during pregnancy or in the post-partum period. The frequency of this complication is most likely underestimated, since benign forms remain latent and the severe forms, responsible for sudden death, eludes the diagnosis in the absence of anatomical confirmation.

Severity of nursing-bottle syndrome and feeding patterns in Kuwait.

On the basis of extensive clinical experience, a classification scheme for nursing-bottle syndrome (NBS) has been empirically constructed to reflect the progression and severity of the disease. Patients who do not have NBS are assigned a score of zero. Patients with NBS are given a score of 1 if they have caries on the facial or lingual surface of at least one of the primary maxillary incisors and optionally the primary maxillary first molars, a 2 if the buccal surface of one or both of the primary mandibular first molars are also involved, or a 3 if specific multiple surfaces are involved. The feeding pattern classification is as follows: 0 = non abusive, 1 = mildly, 2 = moderately, and 3 = severely abusive. The scoring depends upon the number of feeding times/day, the frequency with which the bottle or breast feeding is given during the might, and the duration of the feeding pattern (in months). Eighty-six cases were reviewed for classification. A chi-square test of a two-way contingency table showed a strong and significant relationship between disease severity and degree of feeding abuse. The findings support the validity of the classification schemes, illustrate the general pattern of NBS progression, and indicate that disease severity is a function of specific combinations of factors.

[Unusual localizations of hydatid cysts. Apropos of 40 cases]. / Les localisations inhabituelles du kyste hydatique. A propos de 40 cas.

The authors report 40 hydatid cysts of rare localization selected during a period of 11 years and represent 10.75% on the whole of the hydatid cysts operated during the same period all localizations dumbfounded. The splenic localization is the more frequent with 15 cases, so 4.9%, it occupies the third place after the classic localizations (liver, lung). The soft tissue and the peritoneum come in fourth position with 9 cases so 2.42% in relation to the whole of the hydatid cysts. A last group constituted by very rare localizations of which the frequency varies from 0.27 to 1.34%. This group includes the renal, pancreatic and mammary localizations. In general the diagnosis set no problem. Clinically, it is the discovery of a cystic mass, of progressive evolution with conservation of the general status, which has evoked the diagnosis. Before the arrival of the echotomography, the confirmation of the diagnosis is particularly operative. Actually this investigation allows an easy pre-operative diagnosis. The treatment is only surgical and adapted to each case. The post-operative results are satisfying. They deplore one death for a second recurrent intra-peritoneal hydatidosis.

[A case of post-traumatic intrapericardial hernia in a child]. / Un case de hernie intra péricardique post-traumatique chez l'enfant.

Rupture of the diaphragm and pericardium after blunt abdominal injury is a rare and serious lesion. This rupture can produce a secondary subacute or chronic cardiac tamponade due to herniation of the abdominal contents into the pericardial cavity. Diagnosis is difficult and therefore rarely mode early. Surgical repair can be made by thoracotomy or laparotomy.

[Hemobilia. 3 cases]. / Hémobilie. Trois observations.

The authors relate three cases of haemobilia. One caused by trauma, the second due to the rupture of aneurysm of the right branch of the hepatic artery into the biliary tract, the third one is of gallbladder origin. The remind the major aetiological factors among which the trauma is the most common cause. Selective angiography is the investigation most likely to provide clue to bleeding its site, and orient the therapeutic choice. There are a connection between the prognosis of this rare condition and the importance of the haemorrhage. It's high mortality (15 à 25%) has relation with the frequency of traumatic aetiology. The prognosis is severe in spite of the progress of diagnosis and therapy.

[Acute intestinal obstruction. General review apropos of 100 cases]. / Occlusions intestinales aiguës. Revue générale à propos de 100 cas.

The authors report 100 cases of mechanic acute intestinal occlusion. 62% of them are men and 38% are women. The average age of the patients is 40 years (6 to 74 years). It is relatively young. The small intestine occlusion predominance has been noticed. These have been more dominated by bridle and adhesions (56%) from which (42%) post operative. The aetiology of colonic occlusion (31%) is dominated by volvulus (20%). The colonic occlusion is rarely caused by cancer (9%). All the patients are operated and 7 died. The mortality depend of the frequent delay of the diagnosis and the mediocre field.

[Hemorrhagic hepatic lesions in toxemia of pregnancy]. / Les lésions hépatiques hémorragiques de la toxémie gravidique.

One case of hepatic hemorrhage during toxemia of pregnancy is reported. This complication occurs in the last trimester of the pregnancy or immediately after labor. The diagnosis is usually made per-operatively. The anatomical lesions are subcapsular hematomes or spontaneous rupture of the liver. Surgery is only treatment and must be conservative. The very high mortality rate has generally been attributable not only to uncontrolled hemorrhage but also to disorders of hemostasis associated and to multiple organe failure.

[Caustic lesions of the upper digestive tract. Apropos of 191 cases]. / Les lésions caustiques du tractus digestif supérieur. A propos de 191 observations.

The authors report 191 cases of caustic burns of the upper gastro intestinal tract. HCL is the most incriminated caustic. 6 of them are severe cases: 2 are dead immediately, 4 were operated in emergency and 3 died. The staging based on fibroendoscopy allow us to make a prognosis. 43% of the cases stage III and 14% stage II developed a stenosis. A nasogastric tube is performed at 135 cases. It's used for an enteral artificial feeding and for oesophageal stenting in burns liable to cause stenosis. Through the results of this study and a review of the literature we may establish a therapeutic schema adapted to our conditions.