Limb salvage is a viable alternative to amputation in many cases of advanced sarcoma. The authors examined their experience with microvascular reconstruction of upper extremity defects after sarcoma resection, focusing on oncologic and functional outcomes. A retrospective analysis yielded 17 patients who underwent 18 free flap procedures and met the inclusion criteria. Most patients (71 percent, n = 12) had recurrent sarcoma at presentation to the authors' institution. Malignant fibrous histiocytoma was the most common pathologic subtype (n = 6). High-grade tumors were present in 94 percent of patients (n = 16). The free flap survival rate was 100 percent. The rectus abdominis flap was the most common free flap used (39 percent; n = 7). Local recurrence occurred in nine flaps (50 percent), and five patients ultimately required amputations. Six patients (35 percent) had distant recurrence. The mean Enneking score for limb function was 73 percent of the maximum (21.9 of 30). The 5-year disease-specific survival rate was 61.3 percent. In select patients with advanced upper extremity sarcoma undergoing limb salvage, microvascular flap reconstruction can provide reliable, safe coverage with reasonable preservation of function.

A single carboxyhaemoglobin (COHb) estimation of late evening blood sample among non-smokers, cigarette smokers, and sheesha smokers was evaluated among Saudis. The COHb level in smokers of 15 to 40 cigarettes a day ranged between 0.7 and 10.3 with a mean value of 6.1 ± 2.58 COHb. Values among sheesha smokers ranged between 6.5 and 13.9 with a mean value of 8.8 ± 1.83, significantly higher than those of cigarette smokers (P < 0.001) for a given degree of exposure to tobacco smoke. (Am J Public Health 1982; 72:722-724.)

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In a retrospective study, the records of 54 Saudi patients constituting 35.2% of the total number of patients with bladder carcinoma presenting to Riyadh Central Hospital over a seven year period (1985G to 1992G) were reviewed. Eighty-one percent of the patients were habitants of the Central Province of Saudi Arabia. Their mean age was 60 ± 14.8 years. Male to female ratio was 5:1; gross hematuria was the main presenting symptom, occurring in 90% of patients. Twenty-four patients presented six months or more after the onset of symptoms. Upper tract deterioration was noted in 50% of cases at the time of initial presentation. A total of 76.9% of bladder tumors were transitional cell carcinoma, 19.2% were squamous cell carcinoma and 3.8% were poorly differentiated. Only 29% were superficial tumors while 71% were at least muscle-invading at presentation. The majority of tumors were of high grade. This study shows that high grade muscle-invading transitional cell carcinoma is the most frequent histological pattern of bladder tumor in Riyadh Central Hospital. Delay in patient presentation associated with a tendency for invasion of bladder tumor in this region resulted in a high percentage of incurable disease.

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