Biomedical subjects

Saleh M Al-Salamah

Publications and source records attributed to Saleh M Al-Salamah.

11 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↗

PubMed2006

Squamous cell carcinoma of colon and rectum.

Primary squamous cell carcinoma SCC of the colon and rectum is a rare malignancy. Less than 100 cases have been reported in literature. We report 2 cases of pure SCC involving the rectum and sigmoid colon. A review of literature has been made starting from the first report in 1919 to the present. We have examined the theories regarding the etiology, available treatment modalities, and prognosis for this variant of colorectal carcinoma. We conclude that this tumor presents later than adenocarcinoma and follows an aggressive course. With a greater awareness among surgeons and pathologists, more cases may become known leading to a better estimation of prevalence and clinicopathological behavior of this tumor.

Adult↗

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

General surgical problems encountered in the Hajj pilgrims.

OBJECTIVE: The study was conducted to evaluate the pattern of general surgical admissions for future planning of staff, cost and other needs of these hospitals. METHODS: The study was conducted in 2 major hospitals in the Holy Shrine in 2 consecutive Hajj years 1423, 1424 (2003, 2004). All general surgical admissions, except those who died in the emergency room or were received dead, were included in the study. RESULTS: A total of 177 patients were admitted in both hospitals in 2 Hajj seasons. There were 139 males and 38 females with mean age of 52.7 years. Acute appendicitis and diabetic foot were the most common cause of admissions. Patients who received operative treatment totalled 87 (49.1%) and 69 (39%) were managed conservatively, while 20 (11.3%) left against medical advice. One patient was referred to higher center immediately after admission. CONCLUSION: The pilgrims are a peculiar class of patients. They should receive the best possible care but keeping in view their special needs. Furthermore, this study will help in future organization of such facilities.

Adolescent↗

PubMed2004

Initial factors predicting rebleeding and death in bleeding peptic ulcer disease.

OBJECTIVE: Bleeding peptic ulcer constitutes approximately half of the cases admitted with upper gastrointestinal bleeding. Although the bleeding episode stops spontaneously in most of them, rebleeding occurs in as much as 10-30% of them and has a mortality rate of 5-10%. In this study, we have evaluated the possible significant predictors associated with this adverse outcome. METHODS: The records of 205 patients admitted to gastrointestinal bleeding unit (GIBU) in Riyadh Central Hospital, during the period May 1996 through to April 1999, with endoscopic confirmed diagnosis of bleeding peptic ulcer disease were reviewed for demography, clinical presentation, hematology, biochemistry, initial blood pressure, nasogastric lavage color, co-morbid disease and endoscopic findings. All the significant factors found initially (P<0.05) were entered into odds ratio and its 95% confidence interval and finally the unconditioned logistic regression model was used to find out the significant independent predictors for both rebleeding and mortality in these patients. RESULTS: The majority of patients (85%) were males and below the age of 60 (73%). Duodenal ulcer was the source of bleeding in 84%. Endoscopy was performed in all patients within 24 hours of admission. Only 15% were actively bleeding at the time of initial endoscopy. Thirty-six patients (17%) rebelled, majority within 72 hours of initial hemostasis. Overall, 11 patients (5%) died, 6 of them were rebleeders. Initial presentation of systolic blood pressure <100 mm Hg, blood in nasogastric tube and visible vessel within the ulcer in endoscopy were independent predictors of rebleeding while initial systolic blood pressure <100 mm Hg and age >60-years were independent predictors of mortality. CONCLUSION: Improvement of outcome in patients with bleeding peptic ulcer disease can be achieved by early detection of those patients who are at risk of adverse outcome. Patients with the above mentioned independent predictors of rebleeding and mortality are best managed in the intensive care unit with endoscopic hemostasis and proton pump inhibitor (PPI) therapy for a minimum of 5-days of admission.

Adult↗

PubMed2003

Outcome of laparoscopic cholecystectomy in acute biliary pancreatitis.

OBJECTIVE: To evaluate the efficacy, safety, and timing of laparoscopic cholecystectomy in the management of mild to moderate cases of acute biliary pancreatitis. METHODS: The medical records of 158 patients admitted to Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia (KSA) from July 1998 to December 2001 were retrospectively reviewed. Acute biliary pancreatitis was diagnosed in patients who presented with abdominal pain with serum amylase level 3 times the normal limits in the absence of hypercalcemia or hyperlipidemia and presence of gallstones on ultrasonography. Severity of the disease was assessed using Atlanta Symposium criteria. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 106 patients (74.6%) on selective basis. One hundred and eighteen patients underwent laparoscopic cholecystectomy after clinical and biochemical resolution of the attack. Standard 4 ports technique was used. Intraoperative and postoperative morbidity and mortality, and postoperative hospital stay were reported. RESULTS: Laparoscopic cholecystectomy was performed in 118 patients and it was possible in 110 cases (93.2%) after 3-8 days of admission. Preoperative ERCP was performed in 106 patients of mild to moderate acute biliary pancreatitis and common duct stones were retrieved in 19 cases (18%). The procedure was converted to open in 8 cases (6.7%). Postoperative complications were nausea and vomiting in 10, atelectasis in 8, chest infection in 3, and prolonged ileus in 2. The wound complication occurred in 4. One patient who had bile leak due to cystic duct stump avulsion at CBD junction was treated by endoscopic sphincterotomy plus stenting and another patient had partial CBD injury repaired primarily over a T-tube. Mean postoperative hospital stay was 2.4 days. One patient died due to uncontrolled arrhythmia and heart failure. CONCLUSION: Laparoscopic cholecystectomy can be safely performed for mild to moderate acute biliary pancreatitis after clinical and biochemical resolution of the attack during the same admission with acceptable morbidity and mortality rates. This strategy will lead to reducing the recurring acute biliary pancreatitis, number of admissions and hospital stay.

Acute Disease↗

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↗