Abdulmohsen A. Al-Mulhim

Thyroid Tuberculosis Mimicking Carcinoma: Report of Two Cases

Abstract.Among 527 patients with thyroid disease who underwent surgery at our hospital during a 20-year period, 2 (0.4%) had tuberculous thyroiditis mimicking carcinoma. The first patient was a 44-year-old man with a solitary thyroid nodule and the second was a 24-year old man with a thyroid abscess. The unexpected diagnosis was made postoperatively and was based on histological findings in both patients. No primary focus was found elsewhere in either patient, and both responded to antituberculous chemotherapy. Although the diagnosis is usually based on examination of resected specimens, recent reports indicate that find-needle aspiration cytology is a cost-effective technique of diagnosing thyroid tuberculosis. A review of 35 cases reported in the English literature is also discussed.

Male gender is not a risk factor for the outcome of laparoscopic cholecystectomy: A single surgeon experience

Background/Aim: Previous studies regarding the outcome of laparoscopic cholecystectomy (LC) in men have reported inconsistent findings. We conducted this prospective study to test the hypothesis that the outcome of LC is worse in men than women. Materials and Methods: Between 1997 and 2002, a total of 391 consecutive LCs were performed by a single surgeon at King Fahd Hospital of the University. We collected and analyzed data including age, gender, body mass index (kg/m2), the American Society of Anesthesiologists (ASA) class, mode of admission (elective or emergency), indication for LC (chronic or acute cholecystitis [AC]), comorbid disease, previous abdominal surgery, conversion to open cholecystectomy, complications, operation time, and length of postoperative hospital stay. Results: Bivariate analysis showed that both genders were matched for age, ASA class and mode of admission. The incidences of AC (P = 0.003) and comorbid disease (P = 0.031) were significantly higher in men. Women were significantly more obese than men (P < 0.001) and had a higher incidence of previous abdominal surgery (P = 0.017). There were no statistical differences between genders with regard to rates of conversion (P = 0.372) and complications (P = 0.647) and operation time (P = 0.063). The postoperative stay was significantly longer in men than women (P = 0.001). Logistic regression analysis showed that male gender was not an independent predictor of conversion (Odds ratio [OR] = 0.37 and P = 0.43) or complications (OR = 0.42, P = 0.42). Linear regression analysis showed that male gender was not an independent predictor of the operation time, but was associated with a longer postoperative stay (P = 0.02). Conclusion: Male gender is not an independent risk factor for satisfactory outcome of LC in the experience of a single surgeon.

A survey of surgical management of acute cholecystitis in eastern Saudi Arabia.

Background/Aim: It is now 60 years since early cholecystectomy was advocated for acute cholecystitis (AC). Yet, surgical opinion remains divided regarding its optimal timing. Furthermore, recent surveys have shown low utilization of early laparoscopic cholecystectomy (LC) for AC. Aim: This survey aimed to assess the current management of AC in Eastern Saudi Arabia. Materials and Methods: A postal survey was conducted by means of a questionnaire sent to 95 surgeons practicing LC. The questionnaire addressed the surgical management of AC in relation to the subspecialty of interest, duration of consultant status, number of cholecystectomies performed per year, and the percentage performed laparoscopically. Results: There were 87 responders (92%); two were excluded from the analysis for different reasons. Early LC was preferred by 71% of the responders. With regard to the timing of LC, there was no significant difference in relation to the surgeons subspecialty of interest or duration of consultant status. However, increased number of cholecystectomies and percentage of cholecystectomies performed with a laparoscopic approach were significantly associated with early LC. Conclusion: Early LC for AC is practiced by the majority of surgeons in Eastern Saudi Arabia. This practice is significantly associated with increased number of cholecystectomies performed as well as with the percentage performed with a laparoscopic approach. According to the current literature, early LC for AC results in a shorter total hospital stay and reduced cost of treatment.

Increased Rate of Cholecystectomy after Introduction of Laparoscopic Cholecystectomy in Saudi Arabia

Abstract. A rapid increase in the rate of cholecystectomy was reported in eastern Saudi Arabia between 1977 and 1986. The aim of this study was to determine whether the rate of cholecystectomy in the same region was still rising after the introduction of laparoscopic cholecystectomy. From 1987 to 1995 a total of 24 hospitals in eastern Saudi Arabia were surveyed using a questionnaire. During the 9-year study period, the rate of total cholecystectomy (open and laparoscopic) increased by 91%. Whereas the cholecystectomy rate decreased by 4% per annum from 1987 to 1990, it increased by 63.7% from 1991 to 1995 after the introduction of laparoscopic cholecystectomy. The increase in the rates of cholecystectomy was observed in all age groups and both sexes. Cholecystectomy was, however, most frequent among the age group 45–64 years followed by the age group 25–44 years. Young and female patients were more likely to undergo laparoscopic cholecystectomy than the open procedure. The rise in cholecystectomy rate deserves further evaluation with regard to the following: reasons for the increased rate of cholecystectomy, cholecystectomy-related morbidity and mortality, and the total costs of cholecystectomy.