HCV core antigen testing versus HCV PCR testing for early detection of HCV infection

HCV core antigen is detectable in serum several weeks earlier than anti-HCV antibodies. Variability in early detection time is even more pronounced in certain groups of patients such as the hemodialysis and immunocompromised where the antibody response may take between 45-68 days to develop. Early detection of HCV core Ag in serum may represent an attractive, cost effective screening tool for such high risk patients. The current study aimed at evaluation of the analytical performance of the Abbott Architect HCV Chemiluminescenat Microparticle Immunoassay [CMIA] in comparison to the standard PCR detection of HCV RNA. In addition, the current study evaluated the possible clinical utility of HCV Ag kit in testing pooled samples from several patients. Samples from 44 HCV patients and 15 controls were analyzed using the CMIA HCV core Ag assay and quantitative PCR. Samples from positive HCV patients were pooled and analyzed using the HCV core Ag assay. The current study demonstrated a sensitivity of 81.0% and specificity of 97.0% for the ABBOTT HCV core Ag kit assay in detecting HCV positive cases compared to quantitative PCR assay. The most important finding of the current study is that HCV core Ag assays may have false negative results at low level viremia [low HCV copy numbers]. The current study does not support using HCV core Ag as a single test for screening possible HCV cases or using HCV core Ag assays on pooled samples. Bigger studies may be needed to strengthen the findings of the current study

Colorectal carcinoma from Saudi Arabia Analysis of MLH-1, MSH-2 and p53 genes by immunohistochemistry and tissue microarray analysis

To document the incidence and role of p53 and DNA mismatch repair proteins in colorectal carcinomas, and to evaluate the relative frequency of major molecular pathways in colorectal cancers from Saudi Arabia. We collected the formalin fixed, paraffin embedded tissues from 154 colorectal tumors [83 patients from King Faisal Specialist Hospital and Research Centre and 71 from Saudi Aramco Dhahran Health Centre] between January 1989 and December 2003. We analyzed the p53 and mismatch repair gene expression [hMSH-2, hMLH-1] by immunohistochemistry in tissue microarray format. Expression loss of at least one mismatch repair gene was found in 33.8% of cases and significantly associated with the right-sided tumor location [p=0.0047]. The p53 positivity was observed in 57.5% of tumors, and was inversely linked to expression loss of mismatch repair genes [P=0.0102]. The strong confirmation of the previously established associations between tumor phenotype, and mismatch repair gene alteration provided strong evidence for the validity of our experimental approach. Together with the higher incidence of right sided location in Saudi [46.6%] than in Western colon cancers [34.9%], the observed high prevalence of mismatch gene expression loss in Saudi tumors argues for a higher importance of microsatellite instability in this population. If confirmed, it will be interesting to see whether an increased level of familial or sporadic microsatellite instability cases is causing this variation

spectrum of breast diseases in Saudi Arab females: a 26 year pathological survey at Dhahran health center

In an attempt to delineate the spectrum of breast diseases in Saudi Arab females, we carried out a retrospective study of all cases of breast biopsies and mastectomies accessioned in the files of surgical pathology in our laboratory for 26 years [1967-1992]. A total of 915 cases were collected. Fibroadenoma was the most common lesion encountered [30.7%], followed by fibrocystic condition [21.1%], carcinoma [14.9%], acute mastitis [7.2%], duct ectasia [4.9%], lactational adenoma [4.8%], intraductal papilloma [2.6%], galactocele [2.4%] and several less frequent lesions. Pathological conditions associated with lactation such as acute mastitis, abscess, granulomatous mastitis, galactocele and lactational adenomas constituted 16.2% of the cases in this series. This high frequency is related to the high fertility rate among Saudi Arab females. The mean age of Saudi Arab females with ductal carcinoma was 47.1 years as compared to 54 years in Western countries. Many patients presented with a large size tumor, skin and/or nipple involvement, as well as a high frequency [61.7%] of axillary nodal metastases in those who underwent axillary nodal dissection. The high frequency of fibroadenoma could be related to the large number of young females in our population. A great increase in the number of cases in the last five years has been observed. This could be related to more awareness among Saudi Arab females of their health problems and the expansion of our medical services

Agenesis of right hemidiaphragm: report of an unusual case of diaphragmatic hernia with review of the literature

We report an unusual case of a newborn female infant who had complete absence of the right hemidiaphragm associated with right lung hypoplasia and abnormal shape of the liver with herniation of abdominal viscera in the chest. We discuss the clinical presentation and post-mortem findings of this rare condition with a review of the literature

Intracranial neoplasms in Jordan: a pathological study of 400 cases

Four hundred cases of intracranial neoplasms were diagnosed and managed at King Hussein Medical Center and Jordan University Hospital in the span of eight years [1979-1983]. The histopathological material available on these cases was reviewed, and the data available regarding age, sex and location were analyzed. The most frequent tumors were Gliomas particularly astrocytomas [56.6%], followed by meningiomas [25.5%], and pituitary adenomas [7.3%] Comparison of our findings to data available from different countries including neighboring Arab countries is made with emphasis on the variations in the frequency of various types of intracranial tumors. In an early study on patterns of malignant neoplasms in Jordan during the five-year period [1965-1969][1], brain tumors were found to be excessively rare, accounting for 0.1 per cent only of all malignant tumors. This was attributed to the lack of neurosurgeons and neurosurgical facilities in Jordan at that time. The patients who were suspected of having intracranial masses were usually sent abroad for treatment, particularly to Lebanon[2] and Egypt. Since then, several neurosurgeons completed their training and returned to the country. They established active neurosurgical services in the major hospitals and proceeded in performing all types of operations, including those concerned with brain tumors[3].ln a recent analysis of 3817 malignant neoplasms diagnosed histologicaliy in the only three pathology laboratories serving the country, during the five year period [1975-1979], 223 cases of brain tumors were encountered representing six per cent of all malignant tumors, a 60 fold increase over what had been reported 10 years earlier. We report our findings on 400 cases of intracranial neoplasm which had been diagnosed histologicaliy at the departments of Pathology of both King Hussein Medical Center and Jordan University Hospital. The majority of the cases came from the neurosurgical services of the corresponding hospital, but a few cases were sent from private or government hospitals. These cases were observed during an eight year period [1976-1983]

Cyclopia: a case study and review

A neonatal, human female cyclopic specimen, with brain exhibiting lobar holoprosencephaly was examined by detailed anatomical dissection. In addition to the pachygyric appearance of the cerebrum, the diencephalon failed to attain its normal position in relation to the cerebral hemispheres. The ethmoid bone was the focal point of skull malformations. Possible mechanisms for the generation of the malformations are discussed. Cyclopia is a monostrity that combines lack of separation of the eyes with lack of cleavage of the prosencephalon. The resulting undivided telencephion with a single ventricular cavity was called a holosphere[1] in contrast to the normal hemispheres with symmetrical lateral ventricles. The term holoprosencephaly, which is widely used now-a days to indicate impaired midline cleavage of the embryonic forebrain, is commonly associated with various gradations of facial dysmorphism including cyclopia, ethmocephaly and cebocephaly. According to its severity, holoprosencephaly has been graded into alobar, semilobar or lobar[2]. In cyclopia, a blind-ended proboscis usually occurs above the eye. In some instance, the proboscis may be absent[3]. In cyclopia, the anterior cranial base has been described as being shortened, roofing a medially placed orbital cavity. The ethmoid and the middle portion of the sphenoid are said to be absent. Also described as missing are the nasal bone, turbinates, vomer, lacrimal bones and premaxilla[4]. The present study examines in detail the gross anatomical abnormalities in a case of cyclopia. Special attention was made to the brain and eyes

neurogenic type of arthrogryposis multiplex congenita: a report of a neonatal fatal form

A female infant affected with the neurogenic type of arthrogryposis multiplex congenita is reported. Gross autopsy findings and histopathological observations are presented with particular reference to the skeletal muscles and the central nervous system. The most striking feature was fatty replacement of most muscles of the limbs. Microscopy of the spinal cord revealed degenerative changes of the anterior horn cells which suggests that the muscular changes were the outcome of neurogenic atrophy. Arthrogryposis multiplex congenita [AMC] is a syndrome of persistent joint contractures present at birth[1-3]. It was first described in 1841 by Otto who called it "congenital myodystrophy[4]". The term "arthrogryposis multiplex congenital", generally accepted at present, was first used by Stern[5] in 1923. Theories concerning the nature of the illness have been varied and contradictory. Analysis of pathological findings indicates that there are two fundamental mechanisms responsible for AMC, namely a neurogenic or a myogenic defect[6,7]

Agenesis of the penis: report of two cases and review of the literature

Two cases of congenital penile agenesis, one associated with other urogenital anomalies and cleft lip and the other associated with imperforate anus and limb deformities are presented. The results of post mortem examination of this rare condition are reported on one case with correlation of the findings to the embryogenic development of the genito- urinary organs. Apenia [congenital absence of the penis] is an exceedingly rare congenital anomaly estimated to occur once in 30 million male births[1]. Since the review of the world literature by Richart and Benirschke in 1960[2] in which they collected 27 cases, an additional 25 cases has been reported. Many of these cases are associated with other anomalies. We report here two cases of agenesis of the penis, one was associated with agenesis of the prostate and seminal vesicles and hydronephrosis as well as cleft lip, with autopsy findings, and the other was associated with imperforate anus and limb deformities

Hemangioma of the urinary bladder - an unusual clinical presentation

A case of a hemangioma of the urinary bladder in a 17year old woman is reported. She presented with proteinuria, urinary frequency, and amenorrhea. Most of the reported hemangiomas of the bladder presented with gross hematuria. Intravenous pyelography and computerized tomography aided in localizing the neoplasm. Hemangiomas of the urinary bladder are rare. Fuleihan and Cordonnier,. in 1969, observed that until 1942, only 42 cases of vesical hemangiomas had been reported[1] Of these, only five were histologieally proven. They collected 21 more cases between 1942 and 1968, all of which were histologically proven. Twenty three additional cases have been reported in the world literature since then. Gross hematuria was the presenting sign in almost all of these patients. The following case presented a clinical problem because of the association of a pelvic mass with urinary frequency, amenorrhea, and proteinuria without gross hematuria. The clinical impression, was that of pregnancy