Pre-operative blood donation: A Saudi experience.

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The role of fine needle aspiration biopsy and frozen section in the management of nodular thyroid lesions.

Full text is available as a scanned copy of the original print version.

Laparoscopic cholecystectomy for acute cholecystitis.

One hundred and eight patients with histopathologically confirmed acute cholecystitis underwent laparoscopic or attempted laparoscopic cholecystectomy in the Security Forces Hospital, from October 1991 to April 1996 were retrospectively reviewed. All the patients had routine laboratory works including abdominal ultrasonography. Females represented 75% and 57% had previous admission. Diabetes mellitus was found in 43.5%. Laparoscopic cholecystectomy was successfully completed in 71.2%. The main reasons for conversion in 31 patients were adhesions and unclear anatomy in 87%. The mean operative time was 96 minutes. Laparoscopic cholecystectomy for acute cholecystitis can be a safe and effective alternative to open cholecystectomy provided a safe dissection of the ductal and vascular anatomy with liberal attitude towards conversion is adopted. Patients presenting with leukocytosis> 15,000/mm3, mass or diabetes are the most likely to be converted to open surgery.

Assessment of severity in acute pancreatitis: Use of prognostic factors.

This prospective study evaluates the value of Ranson's prognostic factors in predicting severity of acute pancreatitis. One hundred-fourteen patients with 124 attacks of acute pancreatitis were studied duringa 4-year period at Riyadh Central Hospital. The majority of patients were Saudi males, their mean age being 46.5 years. Cholelithiasis was the leading cause of pancreatitis. Ranson's 11 prognostic factors were estimated within 48 hours of admission. Sixty-six percent of the cases were graded as mild pancreatitis with less than 3 Ranson's factors present, whereas 34% were classified as severe pancreatitis with 3 or more of Ransosn's factors present. Prognostic factors correctly predicted severity in 6% of patients, but only 36% from the severe group developed severe disease (complications and/or death). Overall mortality was 5.3%. Ranson's prognostic factors help in identifying severe pancreatitis but their accuracy may be improved by the use of modern imaging techniques.

Management of colon injuries.

The controversy regarding the management of colon injuries continues, some favouring primary repair while others lean towards a proximal defunctioning procedure. We have reported our experience in this field over a 4-year period. Forty-three patients with large bowel injuries were treated during this period and two of them died in the immediate postoperative period due to continued haemorrhage. Of the remaining 41 patients, 27 underwent primary repair of the colon and 15 per cent of them developed complications. Fourteen patients had a proximal defunctioning procedure and 50 per cent of them developed complications. When severity of injuries was taken into consideration it showed a linear relationship to complications. We conclude that primary repair of the colon should be the preferred method of treatment in patients with grade I and II injuries.

Pattern of primary gastrointestinal tract malignancy among Saudi nationals: A retrospective study.

This histopathological reports from the central laboratory of Riyadh Central Hospital for between 1404 to 1406H (1984 to 1986) were reviewed retrospectively to determine the pattern of primary cancer of the gastrointestinal tract among Saudi nationals. During the study period, a total of 32,990 histopathological examinations were conducted. Neoplasms were identified in 4683 cases (14.2%); 1772 (37.8%) were malignant and 2911 (62.2%) were benign. The stomach (31%), liver (20%), and esophagus (19%) were the most commonly involved organs. The proportional frequencies of gastrointestinal malignancies differ from those seen in Western countries, although the age and sex distribution are similar. The possible etiological factors are discussed and the need for a cancer registry emphasized.

Acute appendicitis complicating pregnancy.

Appendicitis occurring during pregnancy presents a difficult problem for both the treating gynecological and the surgeon. We studied retrospectively the cases of 52 consecutive patients seen during a four-year period at Riyadh Central Hospital, a large and busy general hospital. The incidence of appendicitis in various stages of pregnancy, along with its symptomatology, physical signs, laboratory results, and operative findings, were analyzed. The rates of complications, especially maternal and fetal mortality, were also analyzed and findings compared with those reported elsewhere. There was no maternal morbidity and a 4% fetal mortality. We concluded that an aggressive approach in the diagnosis and surgical management of these patients reduces the maternal and fetal mortality.

Traumatic hernia of the abdominal wall.

Traumatic hernia of the abdominal wall is unusual and even more so the complete avulsion of muscles from the costal arch. While it is usual to search carefully for diaphragmatic hernia during laparotomy for blunt abdominal trauma, traumatic hernia of the abdominal wall of this nature can be easily overlooked. One such case in a child is presented where the diagnosis was not made at the initial laparotomy following blunt abdominal injury received in a road traffic accident. We believe bilateral avulsion of all the abdominal wall muscles from the costal arch has not been reported before.