Laparoscopic colectomy. Where do we stand?

Laparoscopy has changed our approach to surgery, instrumentation and training. The techniques are evolving for a wide range of surgical procedures outside the biliary tree. Currently available data suggests that laparoscopic colectomy can be completed safely in most cases. It is feasible and offers patient-related benefits similar to those described for other laparoscopic procedures. The advisability of performing laparoscopy for cure of colorectal malignancy has been challenged because the recurrence rates and overall cure rates remain unknown. Until prospective randomized trials resolve these issues neoplastic colon laparoscopic surgery must be the prerogative of selected and specialized centers.

Cutaneous malignant melanoma: Tabuk experience.

Cutaneous melanoma (CM) has a rising morbidity and mortality in the western world but is rare in certain geographical areas including the Middle East. The aim of this study is to define the pattern of CM in this environment over a period of about two decades. A review of associated histological reports, dermatology, plastic general surgical admissions and outpatient census statistic of the North West Military Hospital (N.W.A.F.H.) were carried out from January 1978 to June 1996. The clinico-therapeutic information from both the review case and newly discovered CM was then studied. The result shows that CM is probably rare in the Tabuk military environment and possibly has a low mortality among the affected individuals. The presence of only 2 cases of CM among 73,955 patients over about 20 years suggests that this neoplasm is rare in N.W.A.F.H. Surgery, with localised expert reconstruction, probably offers the best cure for uncomplicated CM in this area. It is suggested that the geographical environment, genetic attributes, custom, attitude, presence of white, painted, sun-reflecting buildings, traditional dress-code and behaviour of the indigenes probably contribute to the suppression of and protection against CM in Tabuk. It is recommended that regular, antimlanoma education awareness programmes among the indigenes and avoidance of sunbathing attitude of the expatriate community should be encouraged in order to maintain this suggested natural selection protection.

Magnetic resonance imaging of the normal and injured lateral collateral ligaments of the ankle.

BACKGROUND AND AIMS: To study the role of MR Imaging in evaluating both normal and injured lateral collateral ligaments of the ankle. MATERIALS AND METHODS: Twenty-four patients with clinically diagnosed inversion injury to the ankle and 20 healthy volunteers underwent Magnetic Resonance Imaging (MRI) of the ankle with special emphasis on the lateral complex ligaments. RESULTS: The anterior talofibular (ATFL) and posterior talofibular ligaments (PTFL) were identified in 100% of the ankles of normal volunteers in the axial plane. The PTFL was identified in 100% in the coronal plane. The calcaneofibular ligament (CFL) was identified in 76% of the ankles in the axial, 84% in the coronal and 88% in the sagittal plane. Of the 24 patients with inversion injury, MRI showed ligament abnormalities in 16 patients, ten of these were isolated ATFL tears, five had combined ATFL and CFL tears and one case showed in addition abnormal signal in the PTFL. MRI revealed associated injuries to other ligaments and other soft tissue and osseous structures of the ankle in twelve patients. CONCLUSION: MRI is a non-invasive, accurate technique for evaluation of the normal and injured lateral collateral ligaments of the ankle.

Anaerobes and fungi in chronic suppurative otitis media.

Microbiology of 102 ears with chronic suppurative otitis media was studied for aerobes, anaerobes, and fungi. Forty-four percent were pure cultures, 33.3% were mixed, and 18.6% had no growth. Seventy-four percent were aerobes, 25% fungi, and only 0.9% anaerobes. Pseudomonas aeruginosa (22.5%) was the most common isolate, followed by Staphylococcus aureus and the Aspergillus species. The possible reasons for low yield of anaerobes and the pathogenic roles of anaerobes and fungi in chronic suppurative otitis media are discussed. It is advocated that in investigating pathogenic organisms in chronic suppurative otitis media, requests should include anaerobes and fungi.

Diagnostic problems of tuberculous cervical adenitis (scrofula).

PURPOSE: This study was designed to review the diagnostic procedure for tuberculous cervical adenitis and propose a simple protocol for the work-up of patients with suspected tuberculous cervical adenitis. Moreover, it served to increase physician awareness of tuberculosis as possible cause of cervical mass. PATIENTS AND METHODS: We performed a retrospective study of 57 patients with tuberculous cervical adenitis who were treated at North West Armed Forces Hospital, Tabuk, Saudi Arabia between March 1989 and April 1993. The results of diagnostic procedures, chest x-ray, tuberculin test, fine-needle aspiration, microbiology culture, and histopathology were reviewed. RESULTS: Forteen percent showed changes in chest x-ray, 92% had positive tuberculin test, and 50% of the culture material grew Mycobacterium tuberculosis. All specimens for histopathology were suggestive of tuberculosis. CONCLUSION: A thorough history and physical examination, tuberculin test, and fine-needle aspiration will help arrive at an early diagnosis of tuberculous cervical adenitis and allow early commencement of treatment before final diagnosis can be made by incisional biopsy and culture. Tuberculosis should be included in the differential diagnosis of neck mass.

Eight years experience of a regional burns unit in Saudi Arabia: clinical and epidemiological aspects.

A retrospective analysis of 435 consecutive admissions to a regional burns unit over an 8-year period is presented. The majority were domestic accidents, while a few were suicidal and two were due to child abuse. Scalds were commoner than flame burns, 70.6 per cent were children under 12 years, 12.4 per cent had > 40 per cent TBSA affected, 66.9 per cent were deep partial or full thickness burns, 24.4 per cent had signs of shock on admission, 13.6 per cent had smoke inhalation injury. In spite of these known adverse factors the overall outcome was satisfactory, with a case fatality rate of 7.4 per cent and a residual disability rate of 10.8 per cent. Good initial resuscitation, a low infection rate (18.4 per cent) and the ready availability of appropriate surgical intervention (35.6 per cent), with good intensive care support, could account for the satisfactory outcome.

Initiating a new renal transplant program: problems and results.

Patients from the North-West area of Saudi Arabia had to travel to Riyadh or Jeddah for renal transplantation and post-transplant follow-up. The administration of the North-West Armed Forces Hospitals Program provided medical expertise and financial support to set up a renal transplant program in this area. Suitable staff members including nephrologists, transplant surgeons, staff nurses social workers and laboratory personnel were recruited. A strong link was established with the Saudi Canter for Organ Transplantation in Riyadh. At the end of two years since establishment, 25 renal transplants (11 cadaver donor and 14 living donor) have been performed. During follow-up, nine patients developed serious infection including pneumonia, wound infection and tubercu-losis; all were managed successfully. Three grafts were lost necessitating graft nephrectomy and there were four deaths. The two-year graft survival is 83.3% and patient survival, 84%. These results are highly satisfactory taking into consideration the fact that our transplant program is new.

Laparoscopic orchidopexy: one-stage alternative for non-palpable testes.

Laparoscopy was utilised in the evaluation of 24 non-palpable undescended testes in 19 children. The procedure was accurate in all patients while ultrasound (US) and magnetic resonance imaging (MRI) failed to localise the testes in most cases. At the same time laparoscopic orchidopexy was performed on 15 testes (62.5%). The remaining testes were either absent or atrophic, in which case they were excised. There were no complications from these procedures and the hospital stay was short. Paediatric laparoscopy is safe and effective in the definitive management of non-palpable undescended testes.

Pyogenic sacroiliitis in children: Diagnostic dilemma and management.

Pyogenic sacroiliitis is a relatively rare condition in children. Vigilance and careful clinical examination of the joint could minimize the delay in diagnosis. In areas endemic for brucellosis, negative serology, raised erythrocyte sedimentation rate, positive magnetic resonance imaging, isotope bone scan and bacteriological culture confirm diagnosis. Appropriate adequate antibiotic therapy for four to six weeks cures the infection and prevents morbidity.

Outcome of commercial renal transplantation: two years follow-up.

The results of living non-related renal transplants from India involving unethical exploitation of the donor are inferior. We followed-up 12 patients from our unit who went to a center in Bombay for renal transplantation and compared the results with our local new renal transplant programme. Two-year graft survival was 70% compared to 88% with our new renal transplant program. Also, we emphasised the human side of the problem. We addressed the problem of shortages of organ donation locally because failure to obtain consent from relatives and the need for intensive public education is required to overcome this problem. Finally, Islamic principles and rules that are related to organ transplantation have been discussed in detail, and the main purpose is to enlighten the Western reader.

Laparoscopic ligation of varicoceles: an anatomically superior operation.

Since December 1991, 25 consecutive symptomatic male patients with 26 varicoceles were treated by laparoscopic ligation of internal spermatic veins under general anaesthesia. Twenty-one patients had either scrotal discomfort or painful swelling and four patients presented with infertility. The mean follow-up period is 5 months (range 3 weeks to 9 months). The procedure has provided a satisfactory outcome in 19 out of 21 patients (90.5%) with scrotal symptoms. Of the four patients presenting with infertility due to oligospermia, three had significantly elevated sperm counts at 3 months which resulted in one pregnancy. So far there has been no recurrence of the varicocele. The main potential advantage of the laparoscopic approach is better visualisation of the anatomy, especially the testicular artery and the collateral venous circulation at the level of the internal inguinal ring. In addition to being less invasive with implied benefits, the endoscopic procedure has enabled identification of multiple veins in 22 out of 26 (84.6%) varicoceles in our series.