Biomedical subjects
Publications and source records attributed to M Sadat-Ali.
A case of dislocation of the shoulder and ipsilateral fracture of the shaft of the humerus is reported. The mechanism of this injury is detailed. The use of the limb lengthening apparatus as an external fixator, which rendered the management of this combination injury easy, is described. The literature on this subject is reviewed.
The authors report an analysis of 57 subclavian vein catheterizations for hemodialysis. A total of 51 patients (34 men, 17 women) kept the Cobe single- and double-lumen catheters for 1,726 days. The youngest patient was eighteen and the oldest seventy-two years of age. There were no catheter-related deaths. Complications were encountered in 9 patients. The only life-threatening complication was cardiac arrest, which occurred during flushing of the catheter. The patient was successfully revived. The other complications were pneumothorax and hydrothorax in 1 patient, catheter site infection in 5 patients, and arrhythmias in 2 patients, which stopped after readjustment of the catheter tips. Their experience indicates that percutaneous subclavian vein catheterization is safe and provides quick access for hemodialysis with no morbidity and mortality if done correctly, patiently, and meticulously. The authors believe that this should be the first choice in patients with reversible renal failure and in patients with chronic renal failure, who are usually elderly and medically compromised, till a permanent vascular access is ready for use.
Two cases of malignant bone tumours in pregnancy are reported. The optimum management is not clearly defined due to the rarity of the condition and limited individual experience. Our patients delivered healthy babies without any signs of maternal malignant disease. Cancer chemotherapy was instituted during the postmortem period. Pregnancy did not appear to exacerbate the tumour growth nor in any way affect the ultimate outcome of the patients.
We report a prospective study of fourteen patients with sickle cell disease who were suffering from septic arthritis. They made up 11% of 129 patients with orthopaedic complications of the disease. The infecting organism in eleven was a staphylococcus, with salmonella in only two. The severity of the condition and its sequelae are described. The best treatment is open surgical drainage and intensive chemotherapy.
Progressive subluxation of the wrist as a sequel to vasoocclusive crisis of sickle-cell disease is described. This shares many features with Madelung's deformity. The management depends on the functional disability and the cosmetic appearance. One of our patients needed surgical correction to improve the deformity and the range of motion.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Following major intracranial surgery in a 35-year-old man, sodium pentothal was intravenously infused to minimize cerebral ischaemia. Intense vasospasm with threatened gangrene arose in the arm used for the infusion. Since the cranial condition precluded use of more usual methods, lidocaine was given intra-arterially, with careful cardiovascular monitoring, to counteract the vasospasm. The treatment was rapidly successful.
Patients with sickle-cell haemoglobinopathy are more susceptible to osteomyelitis than normal people. The commonest causative organism in such cases has been widely reported as the salmonella species. Our findings in a prospective study of 21 consecutive patients with osteomyelitis in sickle-cell haemoglobinopathy show that the staphylococcus species is the most likely causative organism.
Saudi Arabia has now a wealth of sporting facilities of which the youth of the country is making full use. A prospective study of sports related injuries was conducted during the twelve months of 1983. We present an analysis of 846 such injuries seen at the King Fahd University Hospital, Al Khobar. These injuries formed 8.36% of those who attended after an accident for emergency treatment, of which 63% were under 20 years. The majority was sustained during soccer games. The most frequent site of injury was the knee. We believe that specialised Sports Injury Clinics, initially based at the University Hospitals should be established here, to give guidance and education concerning avoidance of injuries, and for the treatment and follow-up of those injured and enable them to return to sports early.
Explore the source record for details and available documents.
Soccer injuries which were seen at the King Fahd University Hospital over a period of 12 months were analyzed. The majority of the patients were under 20 years of age. Two-thirds of the injuries involved soft tissue, while those to the bone and joint comprised one-third. The lower extremity was involved in 59%. Sixteen percent of the injuries were considered severe enough to require inpatient treatment. We feel the high incidence of injuries can be reduced by better guidance and coaching at school and other training levels. At present, these patients are seen in the emergency room of our hospital and subsequently in the orthopaedic and fracture clinics. A specialized sports injury clinic staffed with medical and paramedical personnel with special interest in sports medicine would enable early and effective treatment returning athletes to play without undue delay.
Prospective screening of 173 patients with complaints of backache and a history of ingestion of raw milk yielded 21 patients suffering from brucella spondylitis. The overall incidence of brucellosis was 28 in 10,647 patients; 14 out of 21 (67%) presented with acute signs and symptoms of brucella spondylitis and six patients required hospitalization. The majority of the patients had a positive titre of Brucella melitensis and abortus. In 42% of the patients radiographs of the thoraco-lumbar spine showed bony changes. This study stresses the importance of brucellosis as a cause of backache. In spite of the easy availability of the pasteurized milk, people are still getting infected at an alarming rate. We recommend the formulation of 'A National Brucella Eradication Programme' and its implementation.
We prospectively evaluated the results of ultrasonography in 53 patients of sickle cell disease suspected to have vasoocclusive crisis/acute hematogenous osteomyelitis. The average age was 8.4 +/- 3.40 years (range, 1-14). Twenty-six children were boys and 27 were girls. Seventeen (32%) patients had ultrasonographic changes that suggested acute osteomyelitis. The minimal white cell count was 7,200/mm3, and maximal, 9,900/mm3 (mean, 8,190/mm3) in uninfected patients and in 17 patients, the mean was 10,300/mm3 (7,200-13,600/mm3). The mean erythrocyte sedimentation rate in uninfected patients was 32 for the first hour (19-36 mm), and in infected patients, it was 43 for the first hour (35-38 mm). Pus culture was positive in all infected patients, and the infective organism was Salmonella enteriditis in eight, staphylococcal species in six (S. aureus in four and S. epidermidis in two), and Streptococcus species 1 and 2, anaerobic streptococci. All patients with vasoocclusive crisis were treated with analgesics and intravenous fluids and did not require any further treatment. In patients with acute osteomyelitis, the treatment was incision, drainage and drilling of bone, and antibiotic therapy. We conclude that ultrasonography clearly and decisively differentiated acute osteomyelitis from vasoocclusive crisis in patients with sickle cell disease.
BACKGROUND: This 15-year review presents the status of acute osteomyelitis in sickle cell disease so as to assess the type of infection, infecting organism, mode of treatment and complications. DESIGN: Retrospective analysis of patients seen in the last fifteen years. SETTING: King Fahd Hospital of the University at Al-Khobar and College of Medicine and Medical Sciences, King Faisal University, Dammam, Saudi Arabia. RESULTS: Two-hundred and one patients were treated for acute osteomyelitis in sickle cell disease. These patients had 327 episodes. There were 125 males and 76 females with a mean age of 9.6 years (range 6 months to 33 years). Forty-eight (23.8%) patients had multifocal infection. The most common infecting organism was salmonella species in 84 patients (41.7%) and 71/84 patients were below the age of 12 years. In 39/45 patients who as children grew salmonella species initially had acute osteomyelitis due to other organisms in adult life. In 41 patients more than one organism was cultured and in 11 patients the pus/medullary canal fluid did not grow any organism. Blood culture grew infective organism in 46.80%. Tibia was the commonest site of infection 76/201. The incidence of chronic osteomyelitis was 2.48%. CONCLUSIONS: Even with the improvement of socioeconomic status of the community, acute osteomyelitis is still common and severe in patients with sickle cell disease. In children, the antibiotics should be aimed at the salmonella species, whereas in adults antibiotics must be given to cover other organisms. Aggressive treatment with incision, drilling of bone, drainage and antibiotics for six weeks is required to keep the incidence of chronic osteomyelitis low in these compromised patients.