With the rise of urbanization, change in lifestyles, and food habits, the amount of Municipal Solid Waste (MSW) has been rapidly increasing with the composition constantly changing. Landfilling is the common approach for waste management in Kuwait, and around 90% of municipal wastes are disposed in landfill sites. Therefore, this study focused on the integration of different methods for the process of allocating optimum sites for MSW landfills, in four main stages. The first stage focused on utilizing the gap analysis method for the identification of effective criteria for landfill site selection, by comparing the criteria in Kuwait with the World Bank guidelines, US EPA, and Australia EPA, to suggest the best criteria for landfill site selection. These criteria were applied in the second and third stages to determine suitable locations for landfill sites using the Geographical Information System (GIS). In the last stage, the suitable areas were evaluated by studying the socioeconomic aspects such as distance to waste generation center, the proximity of existing roads, and lifespan to select optimum locations for landfilling. The results indicated that only one site with a total area of 12 km2 was considered optimum for MSW landfill sites in Kuwait. Therefore, moderate suitability areas were indicated to support and provide decision makers with more options. The moderately suitable sites are also suitable for landfilling, but they need to be designed carefully in order to avoid negative impacts on the environment and human health. Therefore, we conclude that there is an urgent need to apply the integrated waste management system in Kuwait, as well as to develop a long-term strategic plan.
To compare the validity of a careful clinical examination with venous Doppler studies in the management of patients presenting with varicose veins.Ninety-five consecutive patients presenting with varicose veins from September 1998 to August 1999 were included in this study. Of the 95 patients, 52 were males and 43 females. Eighty-four were expatriate laborers and 11 Kuwaiti nationals. Seventy-one were active workers under the age of 30. All of the patients underwent a full clinical examination for varicose veins, and a management plan was developed for each patient prior to Doppler venous study. The results of the Doppler studies were then compared with the clinical examination results, and the management plan was changed, if necessary, based on the Doppler results.Both clinical and Doppler examinations were equally effective in diagnosing primary varicose vein and identifying sites of venous incompetence. A family history for varicose veins was found in 21% and standing for a long period of time was a risk factor in 51% patients. The most common symptoms were pain and heaviness. Doppler study findings were useful in changing the management plan of 14 (15%) patients, 6 with recurrent varicose vein and 8 obese patients with chronic venous insufficiency. The majority of the patients (n = 82) benefited from surgery and were free of symptoms.This prospective study demonstrated that detailed clinical examination was sufficient to diagnose most patients suffering from primary varicose veins. Doppler vascular studies were useful in changing the treatment modality for those presenting with recurrent varicose vein or obese patients with signs and symptoms of chronic venous insufficiency with no clinically clear varicosity.
<i>Objectives:</i> To describe a new technique to repair injuries of the common carotid artery. <i>Clinical Presentation and Intervention:</i> A 30-year-old man sustained an iatrogenic injury to the left common carotid artery during surgical dissection of a left branchial cyst. The artery was repaired as follows: the left external carotid artery was ligated distally, its stump was longitudinally opened to create an arterial flap, which was then used to repair the defect in the common carotid artery. The patient remained free of any symptoms throughout 1 year of follow-up. <i>Conclusion:</i> Use of an external carotid flap provides an alternative method of repairing an injured carotid artery.
