Saudi Med J
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To look into all cases with previous one cesarean section who were cared for and delivered at Armed Forces Hospital, Riyadh, between January 1990 and December 1998, to determine its prevalence, final method of delivery, and outline measures of reducing its incidence. ⋯ Patients with one previous cesarean section are three times more likely to have a cesarean section as compared to mothers with unscarred uterus. Reducing the overall cesarean section rate is possible through a closer look at the primary indication for the first cesarean section. A protocol is needed to allow more cases with one or more previous cesarean section to have trial of vaginal delivery under close monitoring and involve the senior staff more in the diagnosis and management of cases of dystocia and the use of Oxytocin when indicated.
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To review all cases of cesarean section in the primigravid mother delivered at the Riyadh Armed Forces Hospital between January 1996 and December 1997. To determine its incidence, describe the clinical indications, outcome and highlight areas of improvement in an attempt to reduce the rate of cesarean section. ⋯ The rate of cesarean section in the primiparas was similar to the rate of cesarean section in the obstetric population. The rate of cesarean section in the primiparas breech was slightly higher than cesarean section in the multiparas breech. Fetal distress was the leading indication for cesarean section in twins and those with cephalic presentation. The rate of cesarean section can be safely reduced by reviewing and auditing the primary indication for cesarean section, the Consultants doing frequent rounds on delivery suites and being involved directly in cesarean section decision, careful interpretation of fetal monitoring and allowing more patients with breech presentation to have vaginal delivery under close observation.
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The high clinical and socio-economical impact of cartilage defects and chondral degeneration is well-known. After trauma or without a known etiology, often young patients suffer from pain and a loss of function leading into a decrease of physical activity and, more severe, into long term disability and unemployment. The clinical use of autologous chondrocyte transplantation was introduced in 1994 reporting the data of a pilot study. The objective of this study is to evaluate the efficacy of this method of surgery. ⋯ Autologous chondrocyte transplantation has to be considered a safe and effective method for the treatment of large full thickness cartilage defects. Alternative treatments are symptomatical: drilling, abrasion, lavage, chondroplasty, or osteotomies. The short term results are promising but a lot of patients have to be treated for osteoarthritis as a consequence of failure with total joint arthroplasty. Osteochondral transplantations have the disadvantage of limited harvesting sites and the impairment of the subchondral bone plate.
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Case Reports
Long term intubation and successful weaning in two children with Guillain-Barre syndrome.
No definite criteria exists in Guillian-Barre syndrome in children regarding prolonged ventilation through an endo-tracheal tube without tracheostomy and successful weaning using a T-piece. Here we report two such cases of Guillian-Barre syndrome requiring prolonged intubation for 56 days and ventilation for 30 days and ultimately successfully weaning them using the T-piece. Both the children eventually made a complete recovery, highlighting the point that in children prolonged intubation and ventilation using the portex tube is equally good, if not, better than tracheostomy with its attendant risks.
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To report on the causes of admissions of diabetic patients to the medical unit of King Abdulaziz University Hospital, mortality and risk factors, associated with high mortality, and to find out possible ways to reduce admissions, cost and mortality. ⋯ Macrovascular complications and uncontrolled blood glucose were the most common causes of admissions. Control of hypertension, hyperlipidemia, cessation of smoking and weight reduction will not only decrease the risk of macrovascular complications, but also in addition to patient's education for tight blood glucose control, will decrease the rate, cost and mortality of diabetic admissions.