Background: To evaluate indication and result of open posterolateral thoracotomy done in the theatre for chest trauma (CT). Methods: During a 5-year period, our team performed thoracotomies in a total of 24 patients out of the 307 patients who had CT. The demographic data, type, mechanism, clinical diagnoses, operative finding, Injury Severity Score, case-fatality rate, and complication of the CT were computed with the descriptive statistics were presented in percentage and fraction. All the surgeries were performed by the same team. Results: Of the 307 patients who sustained CT, 24 patients (7.8%) had open posterolateral thoracotomy done in the theater. The mean age was 31.2 (standard deviation ± 13.10) years with a male-to-female ratio of 7:1. The cause of CT was gunshot injury 13 (54.2%) patients, motor vehicular accident in 5 (20.8%) patients, stab injury in 5 (20.8%) patients, and fall 1 (4.2%) patient. The diagnosis was made following the assessment of the quantity and quality of the output of inserted chest tube, auscultated bowel sounds in the chest, chest radiograph, and chest ultrasound. The operative finding was diaphragmatic injury in 13 patients (54.2%), lung laceration in 5 patients (20.8%), negative in two patients (8.3%), bullet in the pleural space in two patients (8.3%), and trachea-bronchial injury and bleeding internal mammary artery (4.2%) in a patient each. The case-fatality rate was 17.4%. Conclusion: Massive hemothorax remains the most common reason for the thoracotomy with diaphragmatic injury being the most common intraoperative finding. Diaphragmatic rupture should be ruled out before the insertion of chest tube for traumatic hemothorax or pneumothorax.

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Background: Chronic pancreatitis (CP) is an inflammatory disease of the pancreas characterized by progressive fibrosis, morphological changes, leading to exocrine and/or endocrine insufficiency. Tropical pancreatitis (TP) is seen mainly in the younger population with large ductal calculi and calcification. In this study, we evaluate the postoperative outcome and pain relief after Frey's and modified Puestow procedure (mPP) in patients of tropical and alcoholic pancreatitis. Materials and Methods: This is a retrospective review of prospectively collected data of surgically treated cases of CP. A total of 44 surgeries were performed with Frey's procedure in 36 (81.82%) patients; and mPP in 8 (18.18%) patients. The pain had been evaluated by the Visual analog scale in preoperatively and at 1 year follow-up. Results: The etiology of CP was related to chronic alcohol use in 16 patients (36.36%) and TP in 28 patients (63.63%). Abdominal pain relief was achieved in 86.36% of the patients. Postoperative pain relief was achieved in 91.66% and 62.5% of patients undergoing Frey's and mPP, respectively. Postoperative pain relief was better in TP (92.86%) as compared to alcoholic pancreatitis (75%) (P = 0.0968). Postoperative major complications over 30 days (Clavein Dindo Grade IIIa and above) were seen in 6.8%. Conclusion: Frey's procedure was associated with better abdominal pain relief as compared to mPP. Patients of tropical CP experience better postoperative pain relief than alcoholic CP.

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Background: Acute appendicitis is still known as one of the most common abdominal emergencies, one of the challenges encountered by the emergency physician is accurate diagnosis of acute appendicitis. In a trial to overcome these difficulties, this study aimed to assess the diagnostic accuracy of readily available and inexpensive inflammatory markers serum C-reactive protein (CRP) levels, white blood cells (WBCs), and neutrophils count in the diagnosis of acute appendicitis. Methods: This is a retrospective study. Two hundred and forty-one participants who performed appendectomy in King Abdulaziz University Hospital from January 1, 2013, to December 31, 2017, were included in this study, of which 148 (61.4%) were males and 93 (38.6%) were females. Chi-square and t-test were used for statistical analysis. Results: The study included 241 patients; the median CRP, WBCs, and neutrophils were significantly higher in patients who underwent open surgery and in complicated appendicitis compared to noncomplicated ones. Receiver operating characteristic curve analysis revealed higher accuracy of CRP in discrimination of acute appendicitis with a sensitivity and specificity of 94% and 57%, respectively. Conclusion: The diagnostic accuracy of the CRP is greater than the WBCs and neutrophil count. Thus, high serum CRP levels support the surgeon's clinical diagnosis. However, none of the studied markers is 100% diagnostic for acute appendicitis. It is recommended to include CRP measurement as a routine laboratory test in patients with suspected diagnosis of acute appendicitis.

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Introduction: Tobacco smoking has been proven to be a major risk factor for morbidity and mortality. The connections between smoking and postoperative adverse effects are very much recorded across surgical specialties. It has been established that smoking cessation has a major impact in optimizing the surgical outcomes of smokers. This study aims to obtain the perception of knowledge regarding surgery-related adverse effects of cigarette smoking among adult population of Al-Ahsa in Saudi Arabia. Methodology: To assess the knowledge of surgery-related adverse effects of cigarette smoking, an online survey was distributed randomly to all Al-Ahsa population in Saudi Arabia. The participants asked about their biographical data and questions regarding surgery-related adverse effects of cigarette smoking. Responses were analyzed as means and standard deviations for the quantitative variables, and percentages for qualitative categorical variables. The results shows that most of participants have agreed that smoking can increase the risk of future heart and lung problems (79%) and think it is necessary to stop smoking after surgery (69%), while more than a half of all participants did not know that smoking can increase pain (60.8%), infection after surgery (56.2), surgical complications with anaesthesia (51.3%). In this study, only 16.5% agreed that the ideal smoking cessation period before surgery is 4 to 6 weeks. Results: The results suggest that the awareness of smoking related postoperative adverse effects is poor. That is why we recommend starting and implanting a strong pre-operative smoking cessation program to provide the needed information and educational materials, advising smoker to quit and offering referral for behavioral change. Conclusion: The awareness of smoking-related postoperative adverse effects is poor. It is important for health-care providers to raise their patient's awareness and knowledge before the surgery.

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Background: The aim of the present study was to find the utility of upper gastrointestinal (UGI) endoscopy in predicting the persistence of postoperative pain following laparoscopic cholecystectomy (LC) and to find the prevalence of other UGI pathologies before LC. Materials and Methods: Ninety patients ≥18 years of age who have gallbladder stones confirmed by ultrasonography were included in this prospective observational study. All patients were subjected to UGI endoscopy (UGIE) examination 1 day before operation. Postoperative follow-up was done on day 1, 14, and 30 for the symptoms. The primary outcome measure was the persistence of postoperative pain, whereas the secondary outcome measure was the prevalence of UGI pathology. The comparison of quantitative variables and qualitative variables was done using the unpaired Student's t-test and the Chi-square test/Fisher's exact test, respectively. Results: The majority of the patients (63.3%) had atypical symptoms. The incidence of the severity of postoperative pain at day 1, day 14, and day 30 did not differ significantly between typical symptoms group and atypical symptoms group. The postoperative pain at day 14 and day 30 was 62.9% versus 20.0% and 45.7% versus 5.5% in an abnormal UGIE group and normal UGIE group, respectively (P = 0.001 for both). In all 20 (22.2%), 9 (10.0%), 1 (1.1%), 2 (2.2%), and 3 (3.3%) had gastritis, deudenitis, gastric ulcer, deudenal ulcer, and gastrooesophageal reflux disease (GERD), respectively. Conclusions: Patients should undergo UGIE before LC to find the presence other UGI pathology.

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Heterotopic gastric mucosa of the proximal esophagus (HGMPE) also referred to as inlet patch is a salmon-colored patch located just distal to the upper esophageal sphincter. HGMPE is usually asymptomatic detected incidentally during endoscopy. Its clinical significance is mainly acid-related or neoplastic complications. Here, we present a case of a 58-year female presenting in the casualty with two episodes of upper gastrointestinal (UGI) bleeding. UGI Endoscopy revealed a large esophageal ulcer 1.5 cm × 1 cm just below the upper esophageal sphincter (UES). Biopsy from this area revealed a diagnosis of HGMPE. UGI bleed occurring as a complication of inlet patch has been very rarely reported. Only one case in literature is present making this case report the second one. This case highlights the importance of careful endoscopic evaluation of the UES region along with biopsy which may reveal heterotopic gastric mucosa in patients with unexplained UGI bleed.

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Purpose: Patients on dialysis are at high risk for developing secondary hyperparathyroidism. This study explores the effect of parathyroidectomy (PTx) in dialysis patients having secondary hyperparathyroidism with the assessment of the clinical and laboratory outcome. Patients and Methods: A combined retrospective and prospective study of twenty patients with chronic kidney disease (CKD) and secondary hyperparathyroidism who underwent total PTx and autotransplantation in the period from January 2017 to January 2019 after approval from the institutional board of ethics. Results: Of the twenty patients, 17 patients (85%) were symptomatic preoperatively. The most common presentation was generalized bone pain (35%). An early postoperative decrease in the mean serum levels of parathyroid hormone (PTH) and calcium (Ca) level – within 12 h after surgery – was observed. By comparison of the pre- and post-operative laboratory investigations, we found a statistically significant decrease in the value of serum PTH, but there was no statistically significant difference in serum Ca level. Conclusion: Most of our patients improved clinically post-PTx. We recommend PTx for CKD patients with secondary hyperparathyroidism suffering from bone pain, generalized weakness, pathological fractures, and psychological disturbance.

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Paraduodenal hernia (PDH), also called mesocolic hernia, is a rare congenital anomaly. However, it accounts for up to 53% of all internal hernias, but they cause only 0.2%–0.9% of all cases of intestinal obstruction. Clinical findings are often indetermined. Computerized tomography is usually diagnostic; however, the diagnosis is often made intraoperative. PDH carries the risk of morbidity and mortality due to incarceration, leading to bowel obstruction and strangulation if not treated, that is why the patient should be repaired surgically not conservatively when the diagnosis is made. Here, we present a case of left-sided PDH with low-grade partial bowel obstruction, who underwent laparoscopic exploration and reduction of small bowel content that founded to be healthy and viable.

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