Platelet aggregation and physiological anticoagulants in sickle-cell disease

During the period January 2002-December 2004, we assessed 30 sickle-cell anaemia patients admitted to hospital in Al Khobar with vaso-occlusive crisis for levels of antithrombin (AT) III, protein C (PC) and protein S (PS). We also did platelet aggregation studies. Steady state levels were assessed during follow-up and compared with 36 adult controls. Levels of PC, PS and AT III in the control group were significantly higher than in those in vaso-occlusive crisis and those in steady state (P < 0.001). There was a statistically significant difference between controls and patients for all platelet aggregation factors except adrenaline. There was no significant difference between the levels of PC, PS, AT III and platelet aggregation variables in patients in the steady state and in vaso-occlusive crisis.

Laparoscopic diagnosis of peritoneal tuberculosis

BACKGROUND

The value of laparoscopy in diagnosing peritoneal tuberculosis (TB) is well described by gastroenterologists but infrequently by surgeons. This report describes a single surgeon's experience with laparoscopic diagnosis of peritoneal TB.

METHODS

A total of 21 consecutive patients with peritoneal TB diagnosed at laparoscopy from January 1995 to December 2002 were prospectively reviewed. Their clinical data, laparoscopic findings, and outcome are described.

RESULTS

There were 11 females and 10 males; the mean age was 36.6 years. Fever (81%) and ascites (66.7%) were the most common clinical features. Laparoscopy under general anesthesia was successful in all patients, and there was no laparoscopy-related mortality. Histology confirmed TB in 17 patients; the remaining four had nonspecific inflammation. All had satisfactory response to anti-TB therapy except one patient with systemic lupus erythematosus, who died after initiation of treatment.

CONCLUSIONS

Laparoscopy is safe and readily establishes the diagnosis of peritoneal TB.

Frequency of ABO blood groups in the Eastern region of Saudi Arabia

OBJECTIVE

To document the frequency of the ABO and Rhesus blood groups in Saudi male donors, and to compare our results with the results of other studies in the Kingdom and elsewhere.

METHODS

This study included a total of 57396 male potential blood donors; 19496 blood donors between the years 1985-1989 (referred to as first period of study) and 37700 blood donors between the years 1995-1999 (2nd period). The blood donors were Saudis, coming to donate blood for various reasons to the Blood Bank Department of King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia. ABO and Rhesus blood groups from 200 Saudi females were also determined. The frequency of ABO blood groups and Rhesus status were calculated separately.

RESULTS

Our results revealed the most common blood group was O, (52%) during the first period of study and likewise the most common blood group (51%) during the 2nd period. The lowest blood group frequency was AB (4%) and (4%) during the first and 2nd period. Rhesus positive blood donors comprised 93% and Rhesus-negative donors were 7% during the first period, while they amounted to 91.5% and 8% during the 2nd period. Overall frequency of ABO and Rhesus blood groups during the 2 periods were the following: O-positive 48% and 46%; A-positive 24% and 24.5%; B-positive, 17% and 17%; AB positive 4% and 4%; O negative 4% and 5%; A negative 2% and 2%; B-negative 1% and 2%; and AB negative, 0.23% and 0.32%. Comparison of our results with the other studies from the Kingdom and other nationalities is also presented.

CONCLUSION

Our results show that the most frequent blood group in Saudis is O-positive. Blood group A is observed at a lower frequency relative to values from Western populations, whereas a significant increase in blood group B combined with a slight increase in blood group AB was recorded. Knowledge of the frequencies of the different blood groups in Saudi Arabia is very important for Blood Banks and transfusion service policies. Knowledge of blood group phenotype distribution is also important for clinical studies (for example disease association), as well as for population studies.

Diaphragmatic injury. A clinical review

OBJECTIVE

Recent experience at King Fahad Hospital of the University, Al-Khobar University, Kingdom of Saudi Arabia was reviewed to identify the pitfalls in the diagnosis of diaphragmatic injuries, and attempt to develop a scheme by which early diagnosis is achieved in order to avoid the sequelae of delayed presentations.

METHODS

A retrospective chart review of patients admitted to the surgical service, with the diagnosis of diaphragmatic injury was undertaken during the period June 1994 through to June 1999.

RESULTS

The total number was 8 patients, and the age ranged between 6-71 years. Of these patients 5 were diagnosed immediately post-traumatic, 2 with delayed presentation, and one with recurrent post-traumatic repair. This case was excluded. Six patients presented following blunt and one after penetrating trauma. Rupture occurred mainly on the left dome of the diaphragm in 5 patients and on the right in 2. Complications ranged from mild chest symptoms to severe respiratory and multi-system involvement.

CONCLUSION

Diaphragmatic injuries occurred in 2%-5% of multiple trauma victims. It is considered a predictor of serious associated injuries, However, as many as 10%-30% are missed during the initial evaluation. A high index of suspicion is required, and judicious use of diagnostic aids should be employed to reach early diagnosis to avoid the sequelae of missed injuries.

Hydatidiform mole: a study of 90 cases

OBJECTIVES

To determine the incidence, epidemiology, complications and management of Hydatidiform mole (HM) at the King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia.

METHODS

A retrospective study was conducted covering a period of 15 years from May 1983 to May 1998. There were 90 cases of hydatidiform mole. The details of maternal characteristics, clinical presentation, tumor behavior, management and complication were studied.

RESULTS

There were 40,700 deliveries during the study period giving an incidence of hydatidiform mole (HM) of 2.2/1000 deliveries. The most common clinical feature was vaginal bleeding which was noted in 81 (90%) cases. Fifty-six (62%) cases had uterus larger than dates, while in 12 (13%) cases, the uterine size was smaller than dates. Ovarian enlargement was noted in 24 (27%) cases. Complications in the form of hemorrhage occurred in 19 (21%) cases and 9 (10%) cases were complicated by cated by sepsis. The complications were more common in patients presenting late to the hospital. There were 6 (6.7%) cases of invasive mole and 3 (3.3%) cases of choriocarcinoma during the follow-ups of the study group.

CONCLUSION

On the basis of this study, the incidence of hydatidiform mole is comparable to the incidence in some oriental countries. Earlier diagnosis and treatment of HM will probably result in the decrease of complications found in this study.

Laparoscopic management of acute small bowel obstruction. Experience from a Saudi teaching hospital

BACKGROUND

The use of laparoscopy has expanded to include the management of acute abdomen. This study describes the author's experience with laparoscopic management of acute small bowel obstruction.

METHODS

From February 1994 through March 1998, 19 patients underwent laparoscopic intervention for acute small bowel obstruction. Their clinical data were analyzed to evaluate the outcome.

RESULTS

A total of 19 patients underwent 20 exploratory laparoscopies. The cause of obstruction was diagnosed correctly in 17 of the patients (90%). Fifteen patients (79%) had adhesions, nine of which were postoperative. Of the 19 patients, 13 (68%) had successful laparoscopic treatment. Laparotomy was required in six patients (32%) for various lesions including ileocecal tuberculosis. The average time for laparoscopy was 58 min. The mean postoperative hospital stay was 5 days. There was no morbidity or mortality in this series.

CONCLUSIONS

Laparoscopy is a feasible and safe alternative to laparotomy for most patients with acute small bowel obstruction.

Immediate discontinuation of intravenous fluids after common surgical procedures

BACKGROUND

Intravenous (IV) fluids and nasogastric (MG) intubation can be discarded safely in some abdominal operations, but this practice seems rare in our community.

SETTING

A University teaching hospital in Eastern Saudi Arabia.

AIMS

To determine the feasibility of the practice in our setting and increase clinicians' awareness of it and encourage its general adoption.

METHOD

A prospective verification study in consecutive ASA Classes I and II adult patients scheduled for four commonly performed operations.

END POINTS

The practice was considered successful if the patient accepted early oral fluids and did not require re-insertion of IV line.

RESULTS

The operations studied were appendicectomy (44), laparoscopic cholecystectomy (35), herniorrhaphy (19) and diagnostic laparoscopy (2). The patients' mean age was 34.1 years (range 14 to 68); 60% were males. The overall success rate was 98%. Thus postoperative IV fluids proved to be unnecessary in these patients; cost savings were achieved and treating teams were freed to focus on other patients who truly required IV fluids.

CONCLUSIONS

In our setting also, routine IV fluids are unnecessary and can be discarded safely after appendecectomy, cholecystectomy and herniorrhaphy in adults.

Pediatric inguinal hernia: Outcome of repair

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

Laparoscopic cholecystectomy is feasible and safe in acute cholecystitis

OBJECTIVE

To assess the feasibility and safety of laparoscopic cholecystectomy in acute cholecystitis.

SUBJECTS AND METHODS

Between June 1993 and December 1996, 424 consecutive patients underwent laparoscopic cholecystectomy; 45 (10.6%) had acute cholecystitis confirmed by ultrasound.

RESULTS

All 45 patients were opened within 72 hours of admission. Conversion to open cholecystectomy was necessary in three patients (6.7%). The mean operating time was 126 minutes (range: 40-300 minutes). There was no mortality or common bile duct injury in this series. The postoperative stay averaged 3.9 days (range: I to 11 days). There was no delayed morbidity after a mean follow-up of 2 years.

CONCLUSION

Laparoscopic cholecystectomy is feasible and safe in patients with acute cholecystitis, provided it is performed by experienced surgeons. Although the procedure is somewhat lengthy, it is associated with low conversion rate, no serious morbidity and zero mortality.

Increased rate of cholecystectomy after introduction of laparoscopic cholecystectomy in Saudi Arabia

A rapid increase in the rate of cholecystectomy was reported in eastern Saudi Arabia between 1977 and 1986. The aim of this study was to determine whether the rate of cholecystectomy in the same region was still rising after the introduction of laparoscopic cholecystectomy. From 1987 to 1995 a total of 24 hospitals in eastern Saudi Arabia were surveyed using a questionnaire. During the 9-year study period, the rate of total cholecystectomy (open and laparoscopic) increased by 91%. Whereas the cholecystectomy rate decreased by 4% per annum from 1987 to 1990, it increased by 63.7% from 1991 to 1995 after the introduction of laparoscopic cholecystectomy. The increase in the rates of cholecystectomy was observed in all age groups and both sexes. Cholecystectomy was, however, most frequent among the age group 45-64 years followed by the age group 25-44 years. Young and female patients were more likely to undergo laparoscopic cholecystectomy than the open procedure. The rise in cholecystectomy rate deserves further evaluation with regard to the following: reasons for the increased rate of cholecystectomy, cholecystectomy-related morbidity and mortality, and the total costs of cholecystectomy.

Current trends in laparoscopic cholecystectomy

Gallstone disease is still a major health problem worldwide. Open cholecystectomy was the standard treatment for symptomatic gallstones for more than 100 years. The introduction of laparoscopic cholecystectomy in the late 1980s has led to dramatic changes in the management of gallstone disease. The aim of this review is to equip the general practitioner with the answers to questions a patient may ask about the current management of gallstones.

Acute appendicitis in pregnancy. A review of 52 cases

Acute appendicitis in pregnancy is the most common non-obstetric complication warranting emergency laparotomy. A retrospective study of 52 pregnant patients who underwent laparotomy for suspected acute appendicitis between June 1982 and June 1995 revealed a histopathological diagnosis in 29 (56%) patients. The hospital incidence for acute appendicitis in pregnancy was 0.09% (1 in 1102 deliveries). There were 10 (19%) patients who presented in the first trimester, 31 (60%) second trimester, 8 (15%) third trimester and 3 (6%) patients in the puerperium. Abdominal pain in the right lower quadrant was the most common presenting symptom. Abdominal tenderness and rebound tenderness were the most common physical signs, although the latter was less marked in late pregnancy. Preoperative laboratory investigations were equivocal in reaching a decision for surgical intervention. Laparotomy was performed within 24 hours of onset of symptoms in 67% of patients. Perforation of the appendix was found in 4 (14%) patients, all of whom had symptoms exceeding 24 hours. Wound infection occurred in 4 (9.6%) patients, 3 of whom had a perforated appendix. There were 2 (9%) fetal losses among the patients with negative laparotomies. Five (17%) other fetuses were lost in the group with diseased appendix, three of these were in patients with perforated appendix. There was no maternal death in the study.