Traumatic diaphragmatic hernia: an Asir region (Saudi Arabia) experience

Ten patients (nine males, one female), seen at the Asir Central Hospital of South-Western Saudi Arabia with proven traumatic diaphragmatic hernia between 1987 and 1997, were reviewed retrospectively. The mean age was 29.6 years, range 5 to 50 years. Chest pain and vomiting were the commonest symptoms. Blunt trauma (road traffic accident--5, fall from height--1, (accounted for 60% of the cases) while gunshot wound and stab wounds were the causes in two patients each. The chest radiograph suggested the diagnosis in all the cases. Barium meal (in two patients) and barium enema (in two patients) complemented the diagnosis. Computed tomography (CT) scan was done in only one patient. Thoracotomy (in 2 patients), laparotomy (in 5 patients) and thoraco-laparotomy (in 3 patients) were the surgical approaches to management. Common herniated organs were liver, stomach, spleen and large bowel. The injuries were on the left side in seven patients and on the right side in three cases. Immediate surgical repair was done in four patients while it was done two days to four years later in others. Complications were minimal and there was only one death.

Diffuse pulmonary calcinosis and multiple soft tissue calcification in renal failure patient with pathological femoral fracture

The rare occurrence of diffuse pulmonary calcinosis is described with case illustration of a patient who presented with a pathological femoral fracture during end-stage renal failure. Associated metastatic soft tissue calcification with parathyroid hyperplasia requiring parathyroidectomy was observed. Roentgenologic evidence of hyperparathyroidism with osteitis fibrosa cystica and a high product of the calcium and phosphate values were indications for the parathyroidectomy. Recent literature review of pulmonary calcinosis and multiple soft tissue calcification is also presented.

Effect of haemoglobin levels on cerebral infarct subtypes at high altitude

In a prospective observational study of haemoglobin (Hb) values of Saudi nationals presenting to Assir Central Hospital, Abha (altitude 2500m) with first-ever acute cerebral infarction, the mean Hb concentration and the proportion of patients with subcortical infarct (SCI) who had Hb values of 14.5g/dl or greater (high normal Hb group), were compared with those of cortical infarct (COI) patients and controls. Thirty-six (22.8%) of 158 patients had SCI and 122 had COI. The mean Hb of SCI patients was 15.2g/dl compared with 14.7g/dl for age and sex matched controls (p = 0.16; NS) and 14.5 g/dl for COI patients (p = 0.10; NS). However, a significantly greater proportion of SCI patients (72%) had high normal Hb values compared with 51% of COI patients (p = 0.02). The difference between the proportion of SCI patients (72%) who had high normal Hb and that of controls (64%) was not significant (p = 0.58). There was a small but significantly increased risk of experiencing SCI as against COI if a patient's Hb value was in the high normal range (odds ratio 2.5; 95% Confidence Interval 1.1 to 5.7 for combined male and female data and 3.8; 95% CI, 1.02 to 13.77 for male patients).