Analysis of laparascopic cholecystectomies in 606 patients: Experience at King Fahad Hospital, Medina.

This is a retrospective study of 606 patients who underwent laparoscopic cholecystectomy at King Fahad Hospital, Medina, Saudi Arabia. The majority of them, 488 (80.5%), were females. Fifty (8.3%) patients presented with acute cholecystitis and 556 (91.7%) were chronic cases. Common bile duct stones were detected in 22 (3.6%) patients. Laparoscopic cholecystectomy was successful in 539 (89%) patients and converted to open cholecystectomy in 67 (11%) patients due to a variety of reasons. The mean operative time was 65.9 minutes. Most of the patients (64.7%) were discharged within 72 hours. There were no deaths in this series. The overall complication rate was 5.6% and the incidence of major ductal injury was 0.8%.

Pattern of cancer in Madina Al-Munawara region.

This is a retrospective study of 2237 histologically proven cases of cancer over a 12 year period from 1981 to 1993. There were 1687 (75.4%) Saudi and 550 (24.6%) non-Saudi patients. Among both sexes, the most common malignancies were from the gastrointestinal tract (29.3%), lymphoma/leukemia (18.4%), head and neck (8.8%) and breast (8.5%). The most common malignancies among males were lymphoma/leukemia, hepatoma, skin and stomach. Among females, the order of frequency of malignancy was breast, lymphoma/leukemia, esophagus, colon and thyroid. Comparison with other leading studies of the Kingdom has been made. The most common malignancies were discussed with the possible etiological factors.

Primary closure of breast abscess compared with the conventional gauze packing and daily dressings.

Because of the reported success of primary closure of Skeletal Muscle abscess we conducted a retrospective study of breast abscess treated over a period of 24 months. There were essentially two groups: In one group the abscess cavities were initially packed with gauze and then dressed daily. In the second group, the abscess cavities were primarily closed and a negative suction drain instituted for about five to seven days. The second group had shorter healing period, better scar formation and reduction of cost in terms of labour and material. But a recurrence could occur within two to three days especially if the drain is removed prematurely.

"Silent" abdominal tuberculosis: a report of six cases.

Six cases of "silent" or subclinical abdominal tuberculosis seen in patients who belong to the upper socio-economic class, but with a humble childhood are presented. The patients are usually from the Third World countries and the condition is often missed or mis-diagnosed. This condition is often precipitated by some stressful situation, and the presentation is not typical of the well-known clinical features of abdominal tuberculosis. This is most likely due to the fact that the high standard of living later in life tends to distort the classical clinical features of tuberculous abdomen as seen in the rest of the population. There is usually a dramatic response to anti-tuberculosis therapy.

Splenic abscess: Presentation, diagnosis and management.

Splenic abscess is infrequently encountered. This paper reports on the diagnosis and management of six cases from Southern Saudi Arabia. Common presenting features were diffuse abdominal pain and fever. Signs localized to left upper quadrant of the abdomen were present in only two patients. The difficulty of diagnosis is signified by the fact that two cases were overlooked during initial surgery. The computed tomographic (CT) scan was quite accurate in three cases while ultrasound was reliable in five patients. Known causes of splenic abscess were present in four of the six patients. Two patients had gangrenous bowel and one each had bacterial and splenectomy. Review of the literature shows that splenectomy remains the treatment of choice while CT-guided aspiration is being increasingly employed especially for the poor-risk patients with unilocular abscesses.

Hydatid disease of the urinary tract: evaluation of diagnostic methods.

Eight patients with histologically proven hydatid disease of the urinary tract underwent eosinophil count, ultrasonography (US) and computed tomography (CT). The findings were compared with those in 8 age-matched controls with simple renal cysts. Eosinophilia was not significantly different in the 2 groups. Mixed echogenicity on US and multivesicular cyst with mixed density on CT were the diagnostic features of hydatid cysts. Using these factors, both US and CT could diagnose or exclude hydatid disease in a significant number of patients with renal cysts. However, CT was more sensitive (88 vs 50%) and accurate (94 vs 75%) than US in the diagnosis of urinary tract hydatid disease. Retrograde pyelography confirmed communicating renal hydatid cysts in 2 patients. A practical algorithm for the investigation of urinary tract hydatid disease is suggested.

Otological manifestations of thalassaemia intermedia: evidence of temporal bone involvement and report of a unique cholesteatoma-like lesion.

Thalassaemia intermedia should be considered in any chronically anaemic patient presenting from the Middle East with hearing impairment. We report here three Saudi siblings with thalassaemia intermedia and features of severe bone marrow expansion, particularly invading the temporal bone. They were seen first for their otological problems before they had access to proper haematological evaluation. One member was admitted for surgical exploration of a cholesteatoma, which was then found to be marrow expansion of the temporal bone. Screening of the family revealed two more anaemic siblings with thalassaemia intermedia. Audiological examination of all the family members showed that only the two affected members had a high frequency sensori-neural hearing loss. Bone marrow expansion into the temporal bone is a rare feature of thalassaemia intermedia. Cholesteatoma-like lesion has not been previously described. It has to be considered in all cases of symptomatic thalassaemia intermedia manifesting with cavitation and lytic lesions in the mastoid system. The likelihood that sensorineural hearing loss may complicate the thalassaemias is raised and the possible mechanism for such involvement discussed. The proper management for different otological manifestations of the thalassaemias is suggested. These cases would suggest a more extensive involvement of the temporal bone in the thalassaemias than has been previously recognized. Further large scale studies are required to illuminate the subject.

Timing of surgery in acute cholecystitis.

Eighty-one cases of cholecystectomy performed over a period of 12 months were reviewed. Those operated upon acutely, those operated upon electively, and those initially treated in the hospital before surgery was performed were compared with regards to the length of hospital stay, injury to the common bile duct, wound infection and mortality rate. There is no significant difference in the mortality rate, but the rate of wound infection 23%, and injury to the common bile duct (17.95%) are highest in those operated upon acutely. It would seem as if the "delayed" surgery, that is, conservative treatment for about a week to two in the hospital before surgery, is preferred if common bile duct exploration or a choledocho-enterostomy is anticipated.