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1.  Stapled Hemorrhoidectomy; Results of a Prospective Clinical Trial in Saudi Arabia 
Objectives: This study was designed to evaluate the effectiveness of stapled hemorrhoidectomy (SH) in terms of cure of the symptoms and post–operative pain control.
Material and Methods: In this prospective clinical study, SH (Ethicon Endo-surgery, Cincinnati, OH) was performed for all patients with grade III and grade IV hemorrhoids, presenting to the surgical clinics of Ohud and Meeqat Hospitals Almadinah Almunawwarah Saudi Arabia. The results of SH were evaluated by a questionnaire focusing on the relief of symptoms, severity of post operative pain, and complications of SH.
Results: Thirty patients (21 males and 9 females); with a mean age of 39.6 years were recruited in this study. Twenty six (86%) patients had grade III and 4 (14%) presented with grade IV hemorrhoids. Perianal prolapse was the most frequent presentation reported in 23 (76%). Mean operating time was 21.7 minutes (range; 17-36 minutes) whereas mean hospital stay was 1.9 days. Post–operative pain was tolerable (non-persistent) in 28 (93%) cases whereas 2 (7%) experienced mild pain requiring additional analgesia. Urinary retention was the most common complication found in 5 (16%) patients. All patients were cured of the hemorrhoids
Conclusion: SH is a safe, rapid, and convenient surgical remedy for grade III and grade IV hemorrhoids with low rate of complications, minimal postoepative pain, and early discharge from the hospital.
doi:10.7860/JCDR/2013/6995.3367
PMCID: PMC3809645  PMID: 24179906
Hemorrhoids; Stapled Hemorrhoidectomy; Post–operative pain; Perianal itching
2.  Surgical management of retrosternal goiter: Local experience at a university hospital 
Annals of Thoracic Medicine  2012;7(2):57-60.
BACKGROUND AND OBJECTIVE:
Retrosternal goiter (RSG) is a term that has been used to describe a goiter that extends beyond the thoracic inlet. Surgery plays an important role in the treatment of these patients, but whether all or selected patients with RSG should undergo this operation remains controversial. Our aim is to look into the demographics, presentation, and treatment of patients with RSG and essentially to determine the role of surgery in its treatment.
SETTING AND DESIGN:
Retrospective study, teaching hospital-based.
METHODS:
Retrospective analysis of 537 thyroidectomies performed at King Khalid University Hospital between 2003 and 2010. The twenty-six patients with RSG were analyzed further, with regard to demographics, presentation, indications, and outcome of surgical treatment. Statistical analysis was performed, where age was expressed as mean and range, and other variables were presented as numbers and percentage.
RESULTS:
There were 26 patients (4.8%) with RSG out of 537 thyroidectomies, who underwent an operation for removal of RSGs, in a seven-year period. The most common presentation was dyspnea (34.6%) and the surgical procedure predominantly used was total thyroidectomy. The RSGs were removed by collar incision in 96% of the cases. The final histological diagnosis revealed malignancy in 26.9% of the thyroid specimens. There was no mortality and minor complications occurred in nine patients.
CONCLUSIONS:
The presence of an RSG is an indication for surgery owing to the lack of effective medical treatment, the higher incidence of symptoms related to compression, low surgical morbidity, and the risk of malignancy.
doi:10.4103/1817-1737.94520
PMCID: PMC3339204  PMID: 22558008
Retrosternal goiter; surgery; thyroidectomy
3.  Incidental parathyroidectomy during thyroid resection: incidence, risk factors, and outcome 
Annals of Saudi Medicine  2011;31(3):274-278.
BACKGROUND AND OBJECTIVES:
Thyroidectomy is a commonly performed procedure for thyroid problems. Inadvertent removal of the parathyroid glands is one of its recognized complications, which occurs more frequently in certain high-risk patients. The aim of this study was to identify the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery.
DESIGN AND SETTING:
A retrospective review of thyroid operations performed at a tertiary referral hospital between January 2004 and December 2008.
METHODS:
Pathology reports were reviewed to identify the specimens that included parathyroid tissue and underlying thyroid pathology. Postoperative calcium levels were reviewed in these patients.
RESULTS:
During the study period, 287 thyroidectomies were performed and 47 (16.4%) patients had incidentally removed parathyroid glands. Risk factors for inadvertent parathyroid resection included total thyroidectomy (P=.0001), Hashimoto thyroiditis (P=.004), and extrathyroidal spread (P=.0003). Postoperative hypocalcemia occurred in 18 (38.3%) of the patients in whom the parathyroid gland was removed inadvertently and in 48 (20%) of the rest of the patients (P=.0123).
CONCLUSION:
The incidence of incidental removal of parathyroid tissue during thyroidectomy is 16.4%. Total thyroidectomy, extrathyroidal extension of the tumor, and thyroiditis were found to be the risk factors. Hypocalcemia was significantly higher among patients who had inadvertent parathyroidectomy.
doi:10.4103/0256-4947.81545
PMCID: PMC3119968  PMID: 21623057
4.  Acute Appendicitis: Is Removal of a Normal Appendix Still Existing and Can We Reduce Its Rate? 
Background/Aim:
To determine the incidence of negative appendectomies and to identify factors that may reduce the risk of having the normal appendices removed surgically.
Design:
Cross-sectional study.
Setting:
College of Medicine and King Khalid University Hospital, Riyadh, Saudi Arabia.
Materials and Methods:
The surgical and histological data of 852 patients who underwent appendicectomy were reviewed. All incidental or interval appendicectomies were excluded. Only patients who were admitted and whose appendices were removed and subjected to histology were included (585 patients). The data on patients who had a normal appendix on histology further analyzed to include demographics, specific investigations, operative findings of the appendix and additional operative findings that need other surgical procedures.
Results:
A normal appendix was removed in 54 (9.2%) of the patients. Only 5.5% of those patients had a computed tomography (CT) scan preoperatively and 3.7% had diagnostic laparoscopy. In 21 patients, additional operative and histological findings were obtained that might have caused the right lower abdominal pain.
Conclusion:
In spite of the advances in the diagnostic and imaging techniques, the rates of negative findings on appendicectomy have not decreased much. Clinical judgment is still the most important factor in the management of patients with suspected acute appendicitis. The routine use of CT scan or diagnostic laparoscopy for all patients who are suspected to have appendicitis is neither cost-effective nor safe.
doi:10.4103/1319-3767.51367
PMCID: PMC2841415  PMID: 19636177
Acute appendicitis; laparoscopy; computed tomography
5.  Effect of fluid preloading on postoperative nausea and vomiting following laparoscopic cholecystectomy 
Saudi Journal of Anaesthesia  2009;3(2):48-52.
Background:
Postoperative nausea and vomiting (PONV) is a common complication following general anesthesia. Different regimens have been described for the treatment of PONV with few that mention the prevention of it. Therefore, we conducted this study to compare the effect of preloading with either crystalloids or colloids on the incidence of PONV following laparoscopic cholecystectomy (LC), under general anesthesia.
Materials and Methods:
This study was carried out on 80 patients who underwent LC. The patients were divided into four groups (each 20 patients), to receive preloading of intravenous fluid, as follows: Group 1 received, 10 ml/kg of low-MW tetrastarch in saline (Voluven™), group 2 received, 10 ml/kg medium-MW pentastarch in saline (Pentaspan™), group 3, received 10 ml/kg of high-MW heta-starch in saline (Hespan™), and group 4, received 10 ml/kg Lactated Ringer's, and this was considered as the control group. All patients received the standard anesthetic technique. The incidence of PONV was recorded, two and 24 hours following surgery. The need for antiemetics and/or analgesics was recorded postoperatively.
Results:
The highest incidence of PONV was in group 3 (75% of the patients) compared to the other three groups. Also the same trend was found with regard to the number of patients who needed antiemetic therapy. It was the highest incidence in group 3 (70%), followed by group 2 (60%), and then group 1(35%), and the least one was in the control group (25%).
Conclusion:
Intravascular volume deficits may be a factor in PONV and preloading with crystalloids showed a lower incidence of PONV.
doi:10.4103/1658-354X.57872
PMCID: PMC2876937  PMID: 20532102
Crystalloid; colloids; postoperative nausea and vomiting; general anesthesia
6.  Anaplastic Transformation of Differentiated Thyroid Carcinoma 
Anaplastic thyroid cancer (ATC) is one of the most aggressive malignancies that arise from transformation of pre-existing differentiated thyroid cancer (DTC). However, the carcinogenic mechanism of anaplastic transformation remains unclear. We describe a case for huge goiter diagnosed as papillary thyroid carcinoma, which underwent thyroidectomy. The final histology showed anaplastic transformation. The clinical and possible etiological aspects are discussed.
PMCID: PMC3068789  PMID: 21475516
anaplastic; thyroid cancer; transformation
7.  FEASIBILITY AND ACCEPTABILITY OF OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE) FOR A LARGE NUMBER OF CANDIDATES: EXPERIENCE AT A UNIVERSITY HOSPITAL 
Objective:
To assess the feasibility and acceptability of using objective structured clinical examination (OSCE) for a large number of medical students.
Methods:
All medical students (291) who had completed the basic surgical course were examined by objective structured clinical examination (OSCE) at the College of Medicine, Riyadh, for the first time. A 5-scale questionnaire was filled by the examiners at the end of the examination each day. Another questionnaire was filled by the students as a feedback.
Results:
All students agreed that the organizational aspect of the examinations was smooth and the time for each station was adequate. 86% of the students agreed that the stations were within the content of the course, 82% agreed that the examination was fair and objective and 93% wanted this method to be followed in the assessment of third year medical students, instead of the traditional examination (written and single long case). Similar responses were received from the examiners who were involved in the exams.
Conclusion:
OSCE is a practical and acceptable method for assessing medical students’ basic surgical skills, even for a large number of candidates, if facilities are available in the examination center. Replacing written exams with OSCE depends on the design of stations to test knowledge adequately in scope and depth probably at problem solving level.
PMCID: PMC3410095  PMID: 23012054
OSCE; medical students; surgery exams

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