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Biomedical subjects

Kamran Khalid

Publications and source records attributed to Kamran Khalid.

12 recordsLinked to original sources
PubMed2006

Transabdominal gastro-esophageal devascularization and esophageal transection for bleeding esophageal varices after failed injection sclerotherapy: long-term follow-up report.

BACKGROUND: Management of continued bleeding from esophageal varices despite adequate injection sclerotherapy remains one of the medical and surgical dilemmas. Transabdominal gastroesophageal devascularization and esophageal transection (TGDET) is considered an effective and safe procedure for such patients. AIM: This study aimed at presenting continued evaluation of TGDET. Various problems influencing the early outcome are discussed, and long-term outcome is analyzed. DESIGN: This was a prospective clinical descriptive study. METHODS: Prospective data was collected on 142 consecutive patients managed by one group of surgeons over a 5 year-period and 15 years follow-up after failed injection sclerotherapy for variceal bleeding. Evaluation was made in terms of effectiveness in controlling the acute bleeding, postoperative morbidity and mortality, recurrent bleeding, encephalopathy, and long-term survival. RESULTS: There were 133 men and 9 women. Mean age was 41.8 years. Etiology of portal hypertension was bilharziasis in 54.9% and posthepatitic in 14.8%. Child-Pugh grading on admission was A: 47.2%, B: 28.8%, and C: 14%. Hemorrhage was controlled in all cases. Clinical leak was observed in 5.6%, portal vein thrombosis in 6.3%, and staple line erosion in 2.1% of cases. No patient developed encephalopathy. In-hospital mortality was 12.7%. Complete eradication of varices was observed in 70.6% patients. Recurrent variceal bleeding was noticed in 6.9% of cases. Actuarial 15-year survival for Child-Pugh A patients was 44%, B was 22.5%, and none for C. CONCLUSION: TGDET remains a safe and effective procedure after failure of sclerotherapy when other alternatives are either not indicated or not available.

Adolescent↗
PubMed2006

Surgery for acute abdominal conditions in intellectually-disabled adults.

BACKGROUND: Intellectually-disabled patients with acute abdominal conditions are susceptible to late diagnosis and adverse outcome due to impaired communication, altered behaviour, neurological impairment, associated congenital anomalies, variable reaction to pain and drugs and various difficulties in perioperative management. The present study aims to present the experience of surgery for acute abdominal conditions in intellectually-disabled patients. Various difficulties encountered during the management are highlighted and measures to overcome these problems are discussed. METHODS: A prospective descriptive population study was performed through the prospective collection of data on consecutive intellectually-disabled adults operated for acute abdominal conditions over a 5-year period. Study parameters included demographic details, clinical presentation, diagnostic modalities, operative findings and outcome in terms of morbidity and mortality. RESULTS: Of 19 men and three women with a mean age of 28.3 years, anorexia, vomiting, and increasing abdominal distension were the most common presenting features. History of pica was available in 36.4% of patients. Intestinal obstruction, acute appendicitis, volvulus and pseudo-obstruction of the colon were the most frequently encountered conditions. Postoperative morbidity and mortality were 33 and 23%, respectively. CONCLUSION: Intellectually-disabled patients demand particular clinical expertise owing to various difficulties inherent to their mental and physical disabilities. Short history, anorexia, vomiting and abdominal distension should make the clinician aware of the possibility of an acute abdominal condition. History of pica should be considered a serious clinical correlate. A high index of clinical suspicion, intensive perioperative care and low threshold for an early operation are recommended to reduce the higher morbidity and mortality figures.

Abdomen, Acute↗
PubMed2006

Spectrum of general surgical problems in the developmentally disabled adults.

OBJECTIVE: This study highlights the spectrum of general surgical problems necessitating admission on intellectually disabled adult patients. Problems encountered in the management and the ways to overcome various difficulties are highlighted. METHODS: Prospective collection of data on 63 consecutive developmentally disabled adult patients admitted to the Department of General Surgery, Riyadh Medical Complex (RMC), Riyadh, Kingdom of Saudi Arabia for various indications from January 2000 through December 2004. Demographic details, clinical presentation, diagnostic modalities, associated physical and neurological disabilities, coexisting medical condition, treatment options, morbidity and mortality were analyzed. Various difficulties encountered during the management and mean to overcome these problems are addressed. RESULTS: Sixty-three patients accounted for 71 admissions. Mean age was 26.7 years with a male preponderance (4.25:1). Fifty-four patients were admitted for various emergency conditions. History of pica could be obtained in 33% of the cases. Twenty-seven patients were admitted for acute abdomen. Volvulus of the colon (22.2%) and pseudo-obstruction (18.5%) were the most common causes of acute abdomen. Twenty-one patients were admitted with upper gastrointestinal bleeding. Reflux esophagitis was the most common cause of bleeding (62%). Overall morbidity was 41% for emergency admissions and 22% for elective surgery. Hospital mortality was 21.4% for emergency surgery. There was no death in elective cases. CONCLUSION: Developmentally disabled patients comprise a special class of patients with peculiar management problems. The treating clinician should be aware of various unexpected conditions not found as frequently in the normal patient population. Apparent lack of pain does not exclude an acute emergency. Possible surgical condition should be suspected if there is vomiting, abdominal distension, fever, increased irritability of recent onset. Male gender and history of pica are added risk factors.

Adolescent↗
PubMed2006

Suture versus mesh repair for incisional hernia.

OBJECTIVE: To compare suture with mesh repair, for incisional hernia in terms of early and late outcomes. METHODS: We reviewed the records of all the patients who presented with primary or recurrent incisional hernia in the Department of General Surgery, Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia, from January 2000 to December 2004. We divided patients, who underwent repair, in 2 groups: Group A (suture repair) and Group B (mesh repair). The information recorded for both groups included gender, age, associated systemic illness, site of hernia, initial surgery, number and type of previous hernia repairs, size of hernial defect, techniques of repair, and hospital stay. The principal early and late outcome measures studied were septic complications and recurrence. RESULTS: A total of 123 patients qualified for the study, 72 in group A and 51 in group B. Wound infection was 5.5% in group A versus 3.9% in group B (p=0.51). Follow up ranged between 6-58 months (mean 37.5 months) for both groups. Fifteen patients (20.8%) developed recurrence in group A, while the recurrence rate in group B was only 5.8% (p=0.04). CONCLUSION: Mesh repair resulted in a lower recurrence rate, and is not associated with increased incidence of wound complications compared with suture repair.

Cesarean Section↗
PubMed2005

Mirizzi syndrome: ten years experience from a teaching hospital in Riyadh.

OBJECTIVE: Mirizzi syndrome (MS) is an uncommon presentation of cholelithiasis. This study aims to find the incidence and analyze the outcome of management of this condition at Riyadh Medical Complex (RMC) with particular reference to diagnostic methods and outcome of surgical treatment. METHODS: Retrospective study on 17 consecutive patients of MS diagnosed and managed at RMC over ten year period. The records were reviewed for demography, clinical presentation, diagnostic methods, operative procedures, postoperative complication and follow up. RESULTS: The incidence of MS syndrome was 0.7% of 2415 cholecystectomies. There was preponderance of Type I variety (58.8%). Ultrasonography was able to diagnose 82% cases. ERCP suggested the diagnosis in all cases and helped further in classifying and management of these patients. All Type I cases were managed with partial cholecystectomy, two underwent laparoscopic surgery. Three Type II patients were managed by partial cholecystectomy alone. Three patients with Type III variety had choledochoplasty whereas one remaining patient with Type IV variety underwent hepatico-jejunostomy. All patients had complete recovery with 17.6% procedure-related morbidity and no hospital mortality. All patients are doing well over a mean follow up 6.5 years. CONCLUSION: Preoperative diagnosis of Mirizzi syndrome by ultrasound and ERCP is essential to prevent serious complications during surgery. Partial cholecystectomy is an adequate procedure for Types I & II MS. Choledochoplasty provides an effective surgical repair in Type III cases. Although laparoscopic cholecystectomy in MS may be hazardous, it may still be tried in preoperatively diagnosed type I cases, provided the surgeon is experienced and keeps a low threshold for conversion open surgery.

Adult↗
PubMed2005

Outcome of surgery for parotid tumours: 5-year experience of a general surgical unit in a teaching hospital.

BACKGROUND: Most of the recent reports on the surgical management of parotid gland disorders come from specialist divisions of otolaryngology, head and neck, or faciomaxillary surgery. The aim of the present study was to evaluate the outcome of surgery for parotid tumours in a general surgical unit of a teaching hospital. METHOD: A prospective clinicopathological study was undertaken over a 5-year period for consecutive patients operated on for parotid gland tumours in the King Saud University Unit of Riyadh Medical Complex. Parameters analyzed were demographic details, clinical presentation, diagnostic work-up, type of surgery, and outcome in terms of early and late morbidity. RESULTS: Thirty seven parotid operations were performed on 36 consecutive patients. All patients presented with parotid gland swelling. Mean age was 51.6 years with a male preponderance. Fine-needle aspiration diagnosed the pathology in 33 out of 37 lesions. Pleomorphic adenoma was the commonest pathology observed in 24 patients (64.9%). Warthin's tumour was more common among male patients and was the only pathology with bilateral involvement. Malignant tumour was found in five patients (13.5%). Superficial conservative parotidectomy was the most frequently performed operation (84%). Overall postoperative morbidity was 13.5%. Transient facial nerve palsy was observed in seven cases (19%). There was no recurrence identified in patients with benign diseases during the mean follow up of 38.5 months. CONCLUSION: Parotid gland surgery can still be performed in a general surgery unit with comparable outcome. However, the operation should be performed in units with special interest and experience in surgery for parotid gland disorders.

Adenoma, Pleomorphic↗
PubMed2005

Castleman disease presenting as obstructive jaundice.

A 48-year-old Saudi male was admitted with features of obstructive jaundice. Endoscopic retrograde cholangiopancreatography showed stricture in distal common bile duct CBD. Computed tomography scan revealed lymphadenopathy along CBD and in porta hepatis. Cholangiocarcinoma, lymphoma or metastatic deposits were suspected but no definite preoperative diagnosis could be established. Laparotomy disclosed lymph node enlargement in porta hepatis and along the CBD and lesser curvature of the stomach. Triple bypass procedure was performed to relieve the obstruction. Pathological examination of the lymph nodes showed Castleman disease of hyaline vascular type.

Castleman Disease↗
PubMed2005

Acute small bowel obstruction due to bilharziasis.

Schistosomiasis remains a major world health problem. The disease presents with protean manifestations in the endemic areas. Small bowel schistosomiasis leading to acute intestinal obstruction is an extremely rare clinical presentation. The disease may mimic peritoneal tuberculosis or carcinomatosis intra-operatively. Small bowel bilharziasis leading to obstruction has not been reported in the recent indexed English literature. This report describes a 50-year-old Yemeni male presenting with acute small bowel obstruction due to schistosomiasis. We review the pathological changes in the intestine following schistosomal infection and discuss diagnosis and treatment. We emphasize the importance of histopathology on all surgical specimens.

Abdominal Pain↗
PubMed2004

Primary actinomycosis of the abdominal wall.

Primary actinomycosis of the abdominal wall is a rare clinical entity. Only 7 adequately described cases have been reported in the English literature. We report a case of isolated abdominal wall actinomycosis involving the left lower quadrant of the abdominal wall in a 32-year-old diabetic male. The diagnosis was confirmed by histopathological examination. Surgical drainage of the abscess followed by long-term administration of penicillin resulted in cure. The clinicopathological spectrum of actinomycosis is reviewed and isolated involvement of the abdominal wall is characterized in light of the knowledge acquired from the available literature on this rare clinical presentation. The significance of obtaining tissues for culture and histopathology in all inflammatory lesions is emphasized.

Abdominal Wall↗
PubMed2002

Incidence of differentiated cancer in nodular goiter.

OBJECTIVE: The study aims to determine the incidence of differentiated thyroid cancer in surgically treated thyroid nodules and to study its clinical and pathological aspect. The objective was to formulate a uniform departmental policy for the most appropriate surgical management of this potentially curable disease. METHODS: This is a prospective clinicopathological study carried out at the Department of General Surgery, Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia, from January 1996 through to December 2000. A total of 483 thyroidectomies were performed. Preoperative diagnosis of thyroid cancer was based on clinical and fine needle aspiration cytology (FNAC). The patients were identified as low risk and high risk groups for surgical treatment. The histopathological diagnosis of differentiated thyroid cancer was confirmed in 103 patients (21.3%). The medical records of all these patients were reviewed for age, sex, clinical presentation, investigations and outcome of surgery. RESULTS: A total of 103 patients (21.3%) with histopathologically confirmed differentiated thyroid cancer were studied. The female to male ratio was 4:1. The mean age was 36.7 years. Sixty-five percent of patients were between 21-40 years. Nodular goiter was the most frequent presentation observed in 78.6% cases. Fine needle aspiration cytology was suggestive of malignancy in 86.4% cases. Most of the patients (84.5%) were identified as low-risk. Papillary carcinoma was the most common tumor (89%) followed by follicular cancer (8.7%). Eight percent of patients had cervical lymph node involvement at presentation. Total lobectomy was performed in 50.5% and total thyroidectomy in an additional 29% of patients. Overall operative morbidity was 6.8% with zero mortality. Two (1.9%) patients presented with ipsilateral lymph node recurrence with mean follow up of 26.5 months and underwent limited neck dissection. CONCLUSION: The relatively high incidence of differentiated thyroid cancer in surgically treated nodular is attributed to increased confidence in FNAC and careful patient selection. Total lobectomy with isthmusectomy for low risk and total thyroidectomy for high risk patients may be recommended as the preferred treatment modalities.

Adult↗
PubMed2002

Role of ultrasonography, computed tomography and diagnostic peritoneal lavage in abdominal blunt trauma.

OBJECTIVE: To compare the diagnostic accuracy of diagnostic peritoneal lavage (DPL), ultrasonography and computed tomography in the management of blunt abdominal trauma. METHODS: A retrospective review of the charts of 233 patients with blunt abdominal trauma necessitating admission to Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia was carried out over a 2 year period (January 2000 to December 2001). The diagnostic yields of DPL, ultrasound and computed tomography were analyzed. The results were compared with findings on subsequent laparotomy or ultimate outcome, which continued in hospital observation and conservative management. RESULTS: Mean age was 23 years and 79% patients were male. Road traffic accident remained the most common cause (70%) and 56% patients had multisystem injuries. The sensitivity for DPL, ultrasound and computed tomography scans was found to be 98%, 96% and 98% with an overall accuracy rate of 92%, 95% and 99%. Diagnostic peritoneal lavage showed false positive results with retroperitoneal injuries and missed one small bowel injury and a pancreatic injury, and resulted in one catheter related bowel injury. Computed tomography scan was able to grade, quantify and localize the injury and helped in devising a successful management plan in 76.5% cases. CONCLUSION: Diagnostic peritoneal lavage is a promising bedside investigation, but is invasive with low accuracy for retroperitoneal injuries and high probability of nontherapeutic laparotomy with false positive results. The high sensitivity and accuracy rates of computed tomography justify its use in quantifying and estimating the grade of injury in order to select the appropriate management of trauma victims. Computed tomography is recommended as the initial investigation of choice in hemodynamically stable patients with blunt abdominal trauma.

Abdominal Injuries↗