Laparoscopic appendicectomy: review of 331 cases over 7 years, in a Saudi Arabian hospital.

BACKGROUND AND STUDY AIMS: Laparoscopic appendicectomy had been well established by Semm before the popular breakthrough of laparoscopic cholecystectomy. The aim of this study was to evaluate the role of laparoscopy in the diagnosis and treatment of acute appendicitis. PATIENTS AND METHODS: This is a retrospective study. Patients with signs and symptoms of suspected appendicitis necessitating surgery were selected for laparoscopic management between 1992 and 1999. RESULTS: A total of 331 patients were recruited into the study, 184 (56 %) male and 147 (44 %) female. The appendix was successfully removed laparoscopically in 98 % of the patients. The median operating time was 63.3 minutes, and 93 % of the appendices removed were histologically abnormal. Postoperative complications occurred in 19 patients (6 %), and included wound infection (1 %), enterocutaneous fistula, pelvic abscess, hemorrhage, urinary tract infection, respiratory tract infection, incisional herniae and pain at trocar sites. The mean hospital stay was 2.31 days (range 1 - 10 days). CONCLUSION: Laparoscopic appendicectomy is a safe procedure with low morbidity. It is advantageous in obese patients, patients with other pathology, and patients with an unusual position of the appendix, and it has a low infection rate.

Interpleural catheter analgesia for chronic pain treatment--a case report.

In summary, we present a case in which long-lasting relief of upper abdominal cancer pain was achieved by injections of local anesthetic through the interpleural approach. This technique may be a good alternative to coeliac plexus block in selected cases. Furthermore, if pain relief in such a case proves to be only transient, injections of dilute phenol might provide permanent relief.

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.

The influence of Islamic views on public attitudes towards kidney transplant donation in a Saudi Arabian community.

Public attitudes towards organ donation during life and at death were examined in a randomised survey of 850 individuals, both male and female, in a representative Saudi Arabian community in Riyadh. Demographic categories accounted were age, sex, marital status, cultural and ethnic background, educational level and occupation. Of the sampled population 87% were native Saudi and the mean age was 30.7 years. Students and teachers made up the largest occupational groups and only 8.1% were illiterate. Although only 10.1% of all subjects had signed a kidney donor card, a further 42.6% expressed willingness to do so. Acceptance of organ donation at death was highest amongst males and in the age group below 30 years (P less than 0.05). There was no differential effect of the various demographic sub-groups in willingness for kidney donation during life. Sixty-five per cent were ready to donate to a close relative and 9.3% were even prepared to do so to a non-related recipient. The Islamic view supporting concepts of transplantation provided the strongest positive influence for organ donation both during life and at death. Dread of mutilation and the fear that pre-consent may adversely affect treatment after serious injury proved potent negative influences.

Sonographic findings in scrotal brucellosis.

Six patients with scrotal brucellosis were ultrasonically examined. All cases were of acute onset. Concomitant involvement of testes and epididymes were noted in all cases except one in which the epididymis was spared. Abnormal sonographic findings consisted of enlargement of the testes and epididymes, nonhomogenous hypoechoic diffuse, or focal echo patterns in all cases and a hydrocele in one case.

Transurethral ureteroscopy. Safety guide wire as an aid to a more aggressive approach.

In an unselected, consecutive series of patients, ureteroscopy was carried out for removal or manipulation of stones in 48 patients and for evaluation of suspected ureteric tumours in two. A success rate of 92% was achieved. The use of an intra-ureteric safety guide wire, indwelling throughout the procedure, facilitated ureteroscopic manipulation, minimised complications, reduced the need for subsequent open surgery and has been a prerequisite for our comparatively aggressive approach to ureteric disorders. The procedure may be time-consuming but prolonged manipulation within the ureter seems to carry little morbidity.