rare case of Cowper's syringocele in an adult male: Clinical presentation and management

A 25-year-old male presented with a weak urine stream and increased urinary frequency for six months. Clinical examination and baseline investigations were unremarkable. Flexible cystourethroscopy and magnetic resonance imaging revealed the closed type of Cowper's syringocele. Transurethral laser marsupialization of the syringocele was carried out without adverse events. The patient's symptoms disappeared after surgery and he remained symptom-free through a 15-month period of follow-up

Genome Shuffling of Mangrove Endophytic Aspergillus luchuensis MERV10 for Improving the Cholesterol-Lowering Agent Lovastatin under Solid State Fermentation

In the screening of marine mangrove derived fungi for lovastatin productivity, endophytic Aspergillus luchuensis MERV10 exhibited the highest lovastatin productivity (9.5 mg/gds) in solid state fermentation (SSF) using rice bran. Aspergillus luchuensis MERV10 was used as the parental strain in which to induce genetic variabilities after application of different mixtures as well as doses of mutagens followed by three successive rounds of genome shuffling. Four potent mutants, UN6, UN28, NE11, and NE23, with lovastatin productivity equal to 2.0-, 2.11-, 1.95-, and 2.11-fold higher than the parental strain, respectively, were applied for three rounds of genome shuffling as the initial mutants. Four hereditarily stable recombinants (F3/3, F3/7, F3/9, and F3/13) were obtained with lovastatin productivity equal to 50.8, 57.0, 49.7, and 51.0 mg/gds, respectively. Recombinant strain F3/7 yielded 57.0 mg/gds of lovastatin, which is 6-fold and 2.85-fold higher, respectively, than the initial parental strain and the highest mutants UN28 and NE23. It was therefore selected for the optimization of lovastatin production through improvement of SSF parameters. Lovastatin productivity was increased 32-fold through strain improvement methods, including mutations and three successive rounds of genome shuffling followed by optimizing SSF factors.

Active enhancement of bacillus thuringiensis subspisraelensis toxins and protein-purification

Bacillus thuringiensissub sp. ilsraelensis de Barjac, that produce insecticidal protein endotoxins are used for mosquito control. The bacterium produces several cry and cytoxins that individually show activity against mosquitoes. A CryllA protein IA848, which corresponds to the first 848 amino acids from N-terminal of CryllA-gene was purified from E.coli by Ni-NTA affinity isolation, Q-Sepharose Fast-Flow chromatography and Super-200 size exclusion chromatography. It was determined using laboratory bioassays that the purified-IA848 protein has good insecticidal competitive binding bioassays show that IA848 does not compete with CryIAb for binding to the brush border membrane vesicles [BBM] of the Aedesaegyptiborer and does not compete with CryIAb at concentrations below 400-fold excess of un-labeled CrylAb for binding to the peritrophic matrix [PM] of the insect. This IA848 proved good competitive in control strategies. CryllA protein purification demonstrate molecular mechanism by which CytIA synergizes or suppresses resistance to toxins by providing a binding site for CryIIAa that resulted in an efficient formation of CryIIAa pre-pore that inserts into membranes and forms'fonic pores

Nasopharyngeal carcinoma in Saudi Arabia: clinical presentation and diagnostic delay

Nasopharyngeal carcinoma is commonly advanced at diagnosis. In this study we evaluated the clinical presentation, diagnostic delay and factors affecting delay in nasopharyngeal carcinoma. Data were collected prospectively for 307 newly diagnosed patients, including detailed demographic data, disease history, health care consultations and referral process. Diagnostic delay was classified as patient, professional and overall. Neck lump and nasal obstruction were the commonest presenting symptoms. There was a significant association between delay time of >/= 3 months and advanced stage. Patient's age and otological symptoms were associated with increased overall delay time. Advanced clinical stage at diagnosis was associated with paitents' sociodemographic characteristics

Pattern of neonatal and postneonatal deaths over a decade [1995-2004] at a Military Hospital in Saudi Arabia

To describe and monitor the causes of neonatal and postneonatal deaths in the Neonatal Intensive Care Unit [NICU] over a 10-year-period. This is a descriptive study of all infants who died in the NICU from January 1995 until December 2004 at Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia. Data were collected prospectively on all infants admitted to NICU. The cause of death for each infant was discussed and determined by at least 2 consultant neonatologists. Deaths were classified according to the modified Wigglesworth's classification of perinatal death. During the study period, there were 79871 live births and 526 deaths, in which 446 84.2% were inborn deaths and 80 15.8% were outborn. Of the inborn deaths, 251 infants died between 1-6 days, 103 died between 7-27 days, and 92 died after 27 days. Lethal malformations led to death in 36%, prematurity and its complications in 42%, hypoxic ischemic encephalopathy in 5%, while other specific diagnoses, combined, led to death in 17% of the cases. Prematurity and its complications followed by congenital malformations were the leading causes of death

Renal dysplasia with extrarenal calyces

We describe a case of simple renal dysplasia with extrarenal calyces of the left kidney in a 2-year-old boy. Other anomalies also included pelviureteral junction obstruction and ectopic ureterocele on the same side, as well as grade V vesicoureteral reflux on the opposite side

Leiomyosarcoma of the bladder in a 16-year-old girl with a history of cyclophosphamide therapy for bilateral retinoblastoma during infancy

A 16-year-old female with bladder leiomyosarcoma had a history of bilateral retinoblastoma at 6 months of life. She received cyclophosphamide chemotherapy after surgical enucleation. In this report, we discussed the possible role of retinoblastoma or cyclophosphamide as a target for the development of bladder leiomyosarcoma

Modified Method of Submental Oroendotracheal Intubation

The aim of this paper is to present a modification of submental intubation in the management of airway. Following usual oroendotracheal intubation, the tube and cuff are exteriorized through a laterosubmental incision, and connected to the anesthetic machine. Ten patients comprising 8 panfacial fractures and 2 orthognathic surgical cases have successfully been managed with this approach. There were no complications, no morbidity, and the scar was inconspicuous and esthetically pleasing. The laterosubmental intubation technique is simple, efficacious in the management of severe maxillofacial injuries, orthognathic surgical cases with nasal obstruction and in plastic surgery for concomitant approach to rhytidectomy, lip correction and rhinoplasty. This approach deserves to be widely propagated among specialists working on the face

Prevalence of cervical ribs in a Saudi population

Cervical rib was the first aetiological factor to be described in thoracic outlet syndrome. Symptomatic compression of the neurovascular structures constitutes an indication for treatment. Prevalence of cervical rib in Saudi Arabia has not been previously reported. The present clinico-radiological reports a high prevalence rate in a Saudi population in the Makkah region. Of 1,300 chest radiographs of patients attending the outpatient clinics, cervical ribs were found in 25 [1.9%] and an elongated transverse process in 2 [0.15%]. Seventy-six% were bilateral and 74% in females. Eleven of the 25 patients responded for review in a vascular clinic. Of these 9 were symptomatic. Neurogenic compression was demonstrated in 9 and vascular compression in the other 2. Radiologists and physicians should be cogniscent of the higher prevalence of symptomatic cervical rib in the Arabian Gulf region

Use of local flaps in the repair of oral and paroral defects

This paper evaluates the efficacy of different types of local flaps used in the closure of defects created in and around the oral cavity. Eighteen cases of oral and paroral defects resulting from trauma, infection or tumor ablation were repaired during a 4-year period, from January 1990 to December 1994. The surgical techniques employed in all cases included the use of local flaps such as the buccal flap, buccal fat pad, palatal rotational flap, tongue flap and the cheek advancement flap. These defects varied in size, the smallest being 8x9 mm and the largest 37 x 21 mm. In all 18 cases, healing was complete within 2 weeks, without a second operation. Assessment of the results both functionally and cosmetically was found to be very satisfactory. The reconstruction of defects of the oral cavity and lip with local flaps is preferred over other methods which employ the transportation of distant pedicle flaps, since these involve a second operation for their final repair. The use of local flaps also offers a satisfactory functional and esthetic result of reconstruction at one stage. Therefore, reconstruction with local flaps has great advantages for the patient

Lipoid proteinosis [Urbach-Writhe disease]

In this report, we describe a 26-year-old man who presented with hyperpigmented firm papillomatous growths along the eye lids, back of the neck, axilla, lateral sides of the upper arms and pubic region. He had macroglossia with xerostomia. The pharyngeal mucosa including the posterior pharyngeal wall and tonsils showed infiltration by yellowish grayish material. The patient's voice was hoarse due to thickening of the vocal cords with narrowing of the laryngeal inlet. Both the parotid glands were enlarged, firm and had pneumoparatoid sensation on massaging. Biopsy of the skin lesions showed hyperkeratosis, acanthosis and papillomatosis. The dermis showed homogenous bundles of eosinophilic hyaline material with mantles of similar material surrounding the blood vessels, hair follicles and sweat glands. Parotid sialogram showed grade 3-4 sialectasia. These findings are consistent with "lipoid proteinosis" which is a rare disease with an autosomal recessive mode of inheritance. It usually presents at childhood. The late presentation of this disease in the patient described is unique and has not been reported previously

normal measurements of abdominal aortic diameters in the Saudi population

To identify normal aortic diameters in elderly Saudi people aged 60-80 years. A prospective screening programme by ultrasound for abdominal aortic aneurysm in elderly people carried out in the Jeddah area, Saudi Arabia. The subjects were 392 consecutive candidates attending a clinic for other reasons. Aortic diameter at suprarenal [just above origin of renal artery] mid-aorta and just above bifurcation were measured ultrasonologically by a qualified radiologist. Average mean for whole group was 1.80 +/- 0.02 SD; males have wider aorta [mean= 1.82 cm +/- 0.25 SD] compared with female [mean=1.71 cm +/- 0.25SD] wider diameters were also noted in smokers [p value=0.05]. Overall Saudi aortic diameter are smaller than European diameters

Plasma lipid profile of healthy Saudi population in Makkah region

Five Hundred healthy Saudi subjects aged 10-80 years [48.65 + SEM] [400 males and 100 females] were randomly included in this pilot study from Makkah area for the estimation of plasma lipids. These subjects were subclassified into four age groups with a gap of 15 years. The sample included representative groups of University students, office and executive workers, Religious leaders and the general population. Standard exclusion criteria were laid down. Blood sugar, S. createnine, urea, S. bilirubin, SGOT and SGPT were also estimated along with the lipid profile in the fasting state. The mean total cholesterol TC] and triglycerides [TC] were 191 mg/dl + 2.15 SEM and 172 mg/dl +6.125 SEM respectively. The mean high density lipoprotein [HDL cholesterol] was 41.5 mg/dl being higher in the younger age group. The study revealed that 28% of the subjects had Total Cholesterol >/- 210mg/dl [5.4mmol/L], 16% had HDL cholesterol < 35 mg/dl[0.9 mmol/L] and 35% were active smokers

Arterial embolism in patients with cardiac disease

To define the pattern of aetiological factors and problems in management 29 cardiac patients with 40 acutely ischaemic limbs due to arterial embolism were studied. The mean age was 53 years [range 25-100]. The male to female ratio was 1.2 : 1; and 13 patients were Saudi nationals [44.8%]. There was a delay in management in 18 patients [62%], as they presented after more than 8 h of onset of the ischaemia. Lower limbs were affected in 26 patients [89.7%]. While rheumatic valvular heart disease was found to be the commonest aetiological disease in the non-Saudi patients, atherosclerotic coronary heart disease was encountered more frequently in Saudi patients. Emboli occluded a large artery in 22 patients [75.9%]; four of them were saddle aortic emboli. Embolectomy was considered the treatment of choice and performed on 33 limbs [82.5%] out of the 40 limbs treated, while heparin therapy only was used in treating four limbs [10%]. Seven limbs were amputated, three primary and four after embolectomy. Five of our patients [17.2%] expired and death was associated with a delayed, large peripheral embolism and myocardial ischaemia. In order to increase the chances of saving limbs, early referral of cases is highly recommended, followed by aggressive cardiac and surgical management. Whenever possible, the latter should be performed in vascular units