Although there is a worldwide increase in maxillofacial trauma incidence; the pattern and etiology of these injuries varies from one country to another depending on socioeconomic, cultural, and environmental factors. This study aims to realize the epidemiological characteristics of maxillofacial fractures in our department. A retrospective cross-sectional study of all facial trauma patients admitted to our department during 2009 to 2012. Patients' data including gender, age, etiology of trauma, the pattern and demographic distribution of fractures of maxillofacial skeleton, and associated injuries were analyzed and compared with previously published data. The chi-square test was used with a p value of less than 0.05, which was considered statistically significant. There is a significant increase in maxillofacial fractures incidence in the past 2 years than former ones. There is a male predominance with highest incidence in the age group of 20 to 40 years. Road traffic accident is the most common etiological factor followed by violence. There is increase in mandibular fracture incidence compared with midface. The significant increased incidence of maxillofacial fracture due to motor car accidents and assaults in the past 2 years reflects a behavioral change within the community.
We report five cases of impacted papillary stones and two cases of ampullary carcinoma treated by endoscopic choledochoduodenostomy (ECDT) at Riyadh Armed Forces Hospital (RAFH).The procedure was carried out successfully in all five cases with impacted stones and in one of the two cases of ampullary carcinoma. No complications were noted. In the presence of the necessary endoscopic expertise and in cases of impossible cannulation of the papilla of Vater due to stone impaction or the presence of a papillary tumor, we recommend endoscopic choledochoduodenostomy (ECDT). This approach provides an access to the common bile duct thus allowing appropriate therapeutic procedures on the biliary system to be performed. Endoscopic removal of common bile duct (CBD) stones is an established, effective, and safe procedure, particularly in the very sick and elderly [1][2][3]. However, cannulating the papilla is not always successful and even in experienced hands, there is a failure rate of 10% to 15% [4]. This is particularly the case when gallstones are impacted in the para-papillary region or there are occluding tumors rendering cannulation of the papillary orifice impossible.Endoscopic choledochoduodenostomy (ECDT) was introduced as an alternative procedure for these sort of cases [5,6] and the results have so far been encouraging. Its indications include both impacted papillary stones and palliative treatment for bile duct and ampullary cancer [7].Between 1984 and 1989, we treated seven patients; five with impacted papillary stones and two with ampullary carcinoma using ECDT at the Gastroenterology Unit in Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia. This report describes the procedure in these seven patients and discusses its indications, morbidity, and outcome. Patients and MethodsA total of seven cases (five men and two women) age group 32 to 86 years (mean 59 years) with cholestatic jaundice were managed by the ECDT at the Gastroenterology Unit, Riyadh Armed Forces Hospital.Prior to treatment, all patients were admitted to the hospital, clinically examined, and the relevant blood tests and abdominal ultrasound examinations were performed. At endoscopy, routine premedication with midazolam and buscopan were given intravenously. A side-view duodenoscope (Videoscope JFX IT or IT10) was used.At endoscopy, the papilla was swollen (Figure 1a). After several unsuccessful attempts to cannulate the papilla with a conventional sphincterotome, this was removed and replaced by a needle knife (5 mm wire papillotome). A small incision was then carefully made on the roof of the papilla 1 to 1.5 cm proximal to the assumed site of the orifice and below the transverse duodenal fold (Figures lb and 1c). The flow of bile indicated the establishment of a communication between the common bile duct and duodenal lumen (Figure 1d). The conventional sphincterotome was then reintroduced and contrast was injected to visualize the biliary tree, and the cut further extended superiorly
Forty-two patients with hepatocellular carcinoma (HCC) were seen during two years at Riyadh Armed Forces Hospital (RAFH), Saudi Arabia. As viral hepatitis is common in this country, serological markers for hepatitis B virus (HBV) and the newly identified hepatitis C virus (HCV) were also studied in these patients. Fourteen (33.3%) patients were HBsAg positive, 11 (26.2%) were anti-HCV positive, two (4.8%) were positive for both HBsAg and anti-HCV and five (11.9%) were anti-HBc and anti-HBs positive. The remaining ten patients all were negative for markers. Serological markers were also studied in 1472 blood donors (control group) during the same period. Twenty-two (1.5%) were positive for anti-HCV, 59 (4%) for HBsAg and two (0.1%) for both markers. Our results are in accordance with previous studies carried out elsewhere, and it is suggested that hepatitis C virus like hepatitis B, may play an important etiological role in hepatocellular carcinoma in Saudi Arabia. However, the actual mechanism for oncogenic effect of anti-HCV has not been established.In view of the high incidence of HCC [9], the endemicity of HBV [10] and the recent report on HCV infection in Saudi Arabia [11], we carried out a retrospective study to evaluate the prevalence of HBV markers and anti-HCV in Saudi patients with HCC.
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