The impact of elective diagnostic laparoscopy in chronic abominal disorders

<b>Objectives:</b> Diagnostic laparoscopy has become an integral part of general surgical procedures with the recent advancements in laparoscopic technology. Since surgeons are more oriented in viewing and dissection of different intra-abdominal areas and are proficient in the definitive management of complications in the procedures, diagnostic laparoscopy may be better off in the hands of surgeons. Laparoscopy has proved to be an important tool in final minimally invasive exploration for selected medical patients with chronic abdominal disorders, the diagnosis of which remains uncertain despite employing the requisite laboratory and non-invasive imaging investigations. This retrospective study was done to evaluate the accuracy of elective diagnostic laparoscopy in patients with chronic abdominal disorders and its impact on the management of these patients. <b>Methods:</b> The records of 35 patients, admitted to Riyadh Medical Complex with chronic abdominal disorders and referred to the author by physicians for elective diagnostic laparoscopy from 1999 through 2004, were evaluated for the accuracy and impact of this procedure in the further management of these patients. All 35 patients were investigated by the referring physician. Investigations included hematology, biochemistry, radiology, ascitic fluid analysis, endoscopic and imaging studies and the Mantoux test. These investigations suggested abdominal tuberculosis in 22 patients and intra-abdominal malignancy in 13 patients. They were referred for elective diagnostic laparoscopy and tissue biopsy. <b>Results:</b> Diagnostic laparoscopy confirmed the diagnosis in all patients suspected of malignancy. In patients with suspected abdominal tuberculosis, the laparoscopic diagnosis and biopsy revealed tuberculosis (16 patients), liver cirrhosis (2 patients), Crohn&#x2032;s disease (1 patient), and metastatic carcinoma of terminal ileum (1 patient). In 2 patients the procedure did not reveal any specific pathology. The accuracy of the preoperative investigations for those suspected to have abdominal tuberculosis was 71 &#x0025;. There was 100&#x0025; impact of diagnostic laparoscopy on the management of all 35 patients since, in the 2 patients with negative laparoscopy, at least tuberculosis and malignancy were excluded. <b>Conclusion:</b> Diagnostic laparoscopy in the hands of surgeons proved to have an impact as an investigation technique, where the diagnosis remained uncertain after the laboratory and non-invasive investigations, of selected medical patients with chronic abdominal disorders. It is a minimally invasive procedure which has a high percentage of accuracy in diagnosis and impact in the further management of selected patients

Luxation of Eye ball following trauma: Novel simple treatment

Luxation of the eye globe is a rare occasion but it carries a risk of threat to permanent vision loss especially when associated with very high intraocular pressure. Appropriate intervention should be undertaken instantly. Predisposing factors include; eyes as in shallow orbital sockets, floppy eyelid syndrome, and exophthalmos. Prompt reduction results in restoration of full anatomical and visual recovery in otherwise healthy eyes. We report a case of globe luxation following trauma by door handle in a 65-year-old female, who recovered completely after reposition of the globe using Desmarres Lid Retractors

Electrophysiological evaluation of fleck retina and temporal macular thinning in X-Linked alport's syndrome

We report a 39-year-old with Alport's syndrome. The patient presented with anterior lenticonus, cataract, and a corrected distance visual acuity of 20/25 and 20/60 in the right and left eyes, respectively. Fundus examination revealed generalized retinal flecks sparing the fovea in both eyes. Optical coherence topography showed temporal macular thinning. Normal fundus autofluorescence was observed in both eyes. Full-field electroretinography (ERG) demonstrated normal photopic and scotopic responses, while multifocal ERG showed no reduction of amplitudes generated from the temporal thinned macula, compared to the nasal macula, indicating preserved functional integrity of the retina