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We have evaluated computed tomography (CT) and ultrasonography (US) in 41 patients with hepatic hydatid disease. CT was diagnostic in all patients, while US performed on 36 patients was diagnostic in 34. In the remaining two cases, heavy calcification in one and a large amount of intracavitary air in the other prevented accurate diagnosis. The US findings in the liver regarding cyst form (multilocular or unilocular), size and location were comparable to those of CT. CT detected associated extrahepatic cysts in the abdomen and pelvis in 11 patients while US performed on the same group of patients detected such cysts in seven patients. It is suggested that the entire abdomen and pelvis should be scanned in patients suspected of hydatid disease and when a hepatic lesion is suggestive of the disease.

Background: Chest trauma in childhood is relatively uncommon in clinical practice, and has been the subject of few reports in the literature. This study was undertaken to examine our experience in dealing with chest trauma in children. Patients and Methods:This was a retrospective study of 74 children who sustained chest trauma, and were referred to King Fahad Hospital in Medina over a two-year period. The age, cause of injury, severity of injury, associated extrathoracic injuries, treatment and outcome were analyzed. Results: The median age of the patients was nine years. Fifty-nine of them (80%) sustained blunt trauma, and 15 (20%) were victims of penetrating injuries. Road traffic accident was the cause of chest trauma in 62% of the children, gun shot wounds were seen in five, and stab wounds in 10 children. Head injury was the most common injury associated with thoracic trauma, and was seen in 14 patients (19%), and associated intraabdominal injuries were seen in nine patients. Chest x-ray of the blunt trauma patients revealed fractured ribs in 24 children, pneumothorax in six, hemothorax in four, hemopneumothorax in three, and pulmonary contusions in 22 patients. Fifty-one percent of children were managed conservatively, 37% required tube thoracostomy, 8% were mechanically ventilated, and 4% underwent thoracotomy. Conclusion:The prevalence of chest trauma in children due to road traffic accidents is high in Saudi Arabia. Head injury is thought to be the most common associated extrathoracic injuries, however, most of these patients can be managed conservatively.

Two hundred thirty-four cases of primary gastrointestinal tract malignancy were diagnosed at the histopathology laboratory of Asir Central Hospital over a four-year period, from 1987 to 1990. The current study is a retrospective analysis of these cases regarding rank orders, distribution according to nationality, age and sex, primary sites affected and the histopathologic pattern. Eighty-eight percent of our cases were Saudi and 12% were non-Saudi nationals. The mean age of patients was 60 ± 16 years with a male:female ratio of 2:1. Primary liver cancer was the most common malignancy (29%), followed by gastric cancer (27%), colorectal cancer (21%) and esophageal cancer (13%). Comparison of our findings to those from other provinces of the Kingdom are also included.

A total of 249 patients, undergoing appendectomy for acute appendicitis, were prospectively randomized into two groups. Group I, comprising 132 patients, received sterile normal saline irrigation to the surgical wound at closure. Alternatively, Group II included 117 patients, who received intraoperative topical ampicillin irrigation of the wound. Both groups were comparable with regard to age, sex, duration of symptoms, and severity of appendicitis. All patients additionally received preoperative systemic gentamicin and Flagyl. Wound infection occurred in 5.3% of Group I compared to only 0.9% of Group II (P<0.05). The reduction in infection rate was significant (P<0.05) in histologically proven appendicitis. We conclude that the addition of intraoperative topical ampicillin to systemic gentamicin and Flagyl augments prophylaxis against wound infection in acute appendicitis. Ann Saudi Med 1994;14(3):233-236. A considerable morbidity following appendectomy is caused by wound infection, 1-5 the rate of which ranges from 9% to 30% in early appendicitis and may reach up to 70% in advanced appendicitis.3-6 Systemic antibiotics were shown to reduce the wound infection rate significantly. 3,4,7 In vitro studies demonstrated 100% kill rates with clinically usable concentrations of antimicrobials in irrigating solutions after only 60-second exposure of the organisms. 8,9 Unlike parenterally administered antimicrobials, topical usage was found to attain prolonged effective local concentrations when used in the powder form. 10Experimental studies have shown that the combined use of systemic and topical antibiotics is better in advanced appendicitis than systemic antibiotics alone.11 Similarly, Seco et al. 12 have concluded in a clinical study that prophylaxis with a combination of systemic clindamycin and topical ampicillin solution, when compared with systemic clindamycin alone, was more effective in preventing wound infection after appendectomy, especially in patients with high wound contamination. However, the study of Seco et al. was criticized because the control group wounds were not irrigated with normal saline and clindamycin may not be the systemic antibiotic of choice for many surgeons. This communication aims at investigating the efficacy of the addition of topical ampicillin to systemic antimicrobials in reducing post appendectomy wound infection rate in a properly controlled randomized prospective study. Material and MethodsAll patients who underwent appendectomy through gridiron incision for clinically suspected acute appendicitis were considered for the study. Exclusion criteria were allergy to ampicillin and other systemic diseases requiring systemic antibiotic administration and therefore three patients who were allergic to ampicillin were excluded from the study, as well as another two patients who had valvular heart disease warranting preoperative prophylactic systemic ampicillin in addition to the systemic gentamicin and Flagyl. A total of 254 patients fulfilled the criteria of the study and were random...