Articles: surgery.
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J Egypt Public Health Assoc · Jan 1994
An audit of caesarean section among Saudi females in Jeddah, Saudi Arabia.
In this study the case records of 1414 patients who delivered at Alshaty hospital within one year were examined and some important variables related to caesarean section cases and their outcome were discussed. The caesarean section rate was found to be 9.9%. The high number of grand multigravida and primigravida among these Saudi mothers have contributed to this high caesarean section rate. ⋯ The main indications of caesarean section in this hospital were repeated caesarean section (34.3%), failure of progress (19.3%) and fetal distress 12.9%. The relation and interaction between the three groups were thoroughly discussed based on the mechanisms of these indications. It is concluded that the changing trend of indications of caesarean section was mostly related to the change in departmental management rather than change in the characteristics of the patients.
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It is not always possible to effect immediate closure of wounds and patients' wounds are therefore exposed to risks of desiccation and infection. In the Plastic Surgery Department, Zuider Ziekenhuis, Rotterdam, we have used glycerolized allogeneic donor as a biological dressing in four patients; a polytrauma patient with a compound fracture of the left lower leg; a diabetic with necrotizing fasciitis; a patient with a cat bite on the lower leg, infected with Pasteurella multocida, and a child with large congenital naevi. On clinical grounds there are suggestions of a correlation between the degree of contamination and vascularization of the wound bed and graft take. Furthermore, our experience with the sandwich technique after excision of a large congenital naevus was positive.
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In a double-blind, randomized, placebo-controlled study, 86 patients (44 verum, 42 placebo), scheduled for knee-joint arthrotomies or minor orthopaedic operations received either naproxen, a nonsteroidal antiinflammatory analgesic, or placebo orally in three doses: the first immediately before the operation and the others 6 h and 12 h after the first. The verum group received 1250 mg naproxen in total. Postoperative pain intensity was measured by the category splitting procedure. ⋯ The intensity of typical side effects of opioids and antipyretic anti-inflammatory analgesics (nausea, vomiting, stomachache, headache, vertigo) was low and they were easily controlled in all cases. Lowering of respiratory frequency was not observed. Perioperative administration of the nonsteroidal anti-inflammatory analgesic naproxen results in better pain relief and significantly lower opioid requirements (by about 46%) after minor orthopaedic surgery.
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Over a six-month-period, from 1st March 1988 to 30th September 1988, 127 patients suspected of having ectopic gestation at the Kenyatta National Hospital (KNH) were referred for sonographic examination, of whom 100 (78.7%) had enough data for a final diagnosis. During sonography, ectopic pregnancy was diagnosed in 31 (31%) patients, out of whom 15 (48.4%) were confirmed to have ectopic gestation at laparotomy. Of the 69 who were thought to have other gynaecological disorders at sonographic examination, 2 (2.9%) were later found to have other ectopic gestation at surgery. ⋯ An empty, bulky uterus, demonstrable adnexal mass, pseudo-gestational sac and fluid in the culde-sac, together improved the sonographic positive predictive value to 67.0%. This study has shown that sonography can be used in the diagnosis of ectopic pregnancy at the KNH. However, in order to improve its reliability, further studies are recommended involving a combination of pregnancy test and sonography.