Esophageal trachealization: a feature of eosinophilic esophagitis

Eosinophilic esophagitis [EE] is an inflammatory condition characterized by intense eosinophilic infiltration of the esophagus. EE is frequently misdiagnosed as gastroesophageal reflux disease. Here, we present a child with EE and a characteristic endoscopic finding, "ringed esophagus". An 11-year-old Saudi boy presented with dysphagia for 1 year. He had experienced an intermittent sensation of solid food sticking in his chest, which was relieved by drinking liquids. A barium swallow excluded anatomical causes of dysphagia, but revealed multiple-ringed esophagus. Endoscopy showed a furrowing and trachealizing appearance of the entire esophagus. Hisologically, extensive eosinophilic infiltration was a feature in biopsies obtained from the esophagus. The child responded well to a 2-month course of inhaled fluticasone. Symptoms recurred 3 months after discontinuation of therapy, which necessitated resumption of inhaled fluticasone. The endoscopic appearance of multiple esophageal rings should raise suspicion of EE and be confirmed by esophageal biopsies

Breast diseases in the Northern region of Saudi Arabia

The incidence and pattern of breast diseases varies within countries. There is virtually no information on breast diseases found in the Northern region, Kingdom of Saudi Arabia [KSA]. This study hopes to provide data in this area. We reviewed the histological and clinical records of 708 patients who presented to General Surgery in Prince Abdul-Rahman Al-Sudairy Central Hospital, Sakaka, Al-Jouf, KSA, with breast complaints over an 8-year period [June 1994 and June 2002]. Breast findings were categorized in terms of benign, inflammatory, malignant, congenital and functional. Benign diseases were also evaluated in terms of their proliferative status and cancer risk. The findings in order were benign breast disease in 245 [48.9%] were most common, inflammatory disease, 213 [42.5%], and finally cancer of the breast in 43 [8.6%]. Fibroadenoma was the most common benign disease. Twenty-seven [5.4%] of benign breast disease were lesions with a cancer relative risk ranging from 1.6-4.4. Breast abscess was the most common inflammatory disease. Ductal carcinoma was the most common breast cancer. Breast cancer was bulky and presented late in mostly premenopausal women. Breast diseases are common among our patients. Although benign disease is the most common, some patients have lesions that have a small but definite cancer risk. Of concern is the pattern of advanced breast cancer, which presents mostly in young premenopausal women. A concerted educational program is needed to acquaint the patients with the significance of breast masses

Pattern and incidence of cancer in northern Saudi Arabia

To study the pattern and incidence of cancer in the Al-Jouf region of Saudi Arabia. The record of all confirmed cancer cases were retrieved and studied from the files of the Histopathology and Cytology Department, Prince Abdulrahman Al-Sudairy Central Hospital, Al-Jouf, Kingdom of Saudi Arabia [KSA] during the period 1994 to 2001. The major types of cancer were ranked in order of relative frequency. The crude incidence rate and age standardized rate were then calculated. The age standardized rate in Al-Jouf was 38.5 per 100,000, a figure lower than the Saudi Arabian national average of 71.7 per 100,000 and lower than the lowest published international figure of 39.6 from Gambia. The most common cancers in the whole population irrespective of sex were carcinoma of the breast, lymphoma and leukemia combined and colorectal cancer. The most common cancers in females in Al Jouf were those of the breast, thyroid, and lymphomas and leukemia combined. Comparative findings for males were lymphomas and leukemias combined, colorectal and skin cancers. The incidence of cancer in Al Jouf region appears to be the lowest incidence published to date. The over all pattern of cancer is however similar to the findings in other regions of KSA. Carcinoma of breast, lymphomas and leukemias, and colorectal cancers are the leading cancers in the region