Granulomatous inflammatory response in a case of typhoid fever

To present a case of culture-proven typhoid fever in which granulomas were demonstrated histologically in the ileum and mesenteric lymph nodes. A 47-year-old Pakistani man underwent emergency hemicolectomy for severe bleeding per rectum associated with diarrhea. Two large ulcers in the ileum, near the ileocolic junction, as well as mesenteric lymph nodes showed both necrotizing and non-necrotizing granulomas in addition to mixed inflammatory infiltrate on histology. Typhoid fever may be considered as one of the causes of the differential diagnoses of granulomatous inflammation of the small intestine

Indications of the mechanisms involved in improved sperm parameters by zinc therapy

To determine possible indications of the mechanisms involved in improved sperm parameters by zinc therapy in asthenozoospermic men. Forty-five men with asthenozoospermia [>/= 40% immotile sperm] were randomized into four therapy groups: zinc only: n = 11; zinc + vitamin E: n = 12 and zinc + vitamins E + C: n = 14 for 3 months, and non-therapy control group: n = 8. Semen analysis was done according to WHO guidelines. Malone dialdehyde, tumour necrosis factor-alpha [TNF-alpha], total antioxidant capacity, superoxide dismutase [SOD] and glutathione peroxidase were determined in the semen and serum. Antisperm antibodies IgG, IgM and IgA were evaluated by immunobeads. Sperm chromatin integrity was determined by acid denaturation by acridine orange and sperm apoptosis by light and electron microscopy. The effect of zinc on in vitro induced sperm oxidative stress by NADH was evaluated. Asthenozoospermia was significantly associated with oxidative stress with higher seminal malone dialdehyde [8.8 vs. 1.8 mmol/l, p < 0.001] and TNF-alpha [60 vs. 12 pg/l, p < 0.001], and low total antioxidant capacity [1.8 vs. 8.4, p < 0.01], SOD [0.8 vs. 3.1, p < 0.01] and glutathione peroxidase [1.6 vs. 4.2, p < 0.05], compared to normozoospermia. Zinc therapy alone, in combination with vitamin E or with vitamin E + C were associated with comparably improved sperm parameters with less oxidative stress, sperm apoptosis and sperm DNA fragmentation index [DFI]. On the whole, there was no difference in the outcome measures between zinc only and zinc with vitamin E and combination of vitamins E + C. In the in vitro experiment zinc supplementation resulted in significantly lower DFI [14-29%, p < 0.05] compared to zinc deficiency. Zinc therapy reduces asthenozoospermia through several mechanisms such as prevention of oxidative stress, apoptosis and sperm DNA fragmentation

Serum prostate-specific antigen levels in Middle Eastern men with subclinical prostatitis

To investigate the influence of subclinical or histologically diagnosed prostatitis on serum prostate-specific antigen [PSA] in patients investigated for prostatic disease in Kuwait. Serum PSA was assayed in patients investigated for prostatic disease in Mubarak Al-Kabeer Hospital, Kuwait, between December 2002 and December 2004. These included patients undergoing transrectal ultrasound with needle biopsy of the prostate gland and those who were treated with transurethral resection of the prostate or retropubic prostatectomy. The tissue was evaluated for prostatitis as well as the underlying disease, and the type and severity of prostatitis were compared with levels of serum PSA. Of the 331 tissue specimens, 18 [5.4%] did not show prostatitis, while 233 [70.4%] with benign prostate and 80 [24.2%] with malignant prostate disease showed prostatitis. Of 270 men with known serum PSA levels, 198 and 72 had benign and malignant prostate disease, respectively. Of the 198, 77 [41%] with benign prostate disease and prostatitis and of the 72, 52 [76%] with malignant prostate disease and prostatitis had serum PSA levels >10 ng/ml. The data showed that although raised serum PSA is more commonly associated with prostate cancer, subclinical prostatitis is a significant source of high serum PSA in over 40% of men in Kuwait. That local factors may obscure the usefulness of serum PSA as a screening tool suggests the need for a locally applicable paradigm to identify prostate cancer

BRCA 1 gene expression in breast cancer in Kuwait: correlation with prognostic parameters

This study assessed the BRCA1 gene expression in breast cancer in Kuwait, and compared it with other known prognostic factors for the disease. Materials and Forty-eight random samples of archival paraffin-embedded breast cancer tissues were studied for BRCA1 gene expression. Immunohistochemical method utilizing antibodies against different epitopes on the BRCA1 protein was used to study BRCA1 protein expression. In addition, for 29 patients, reverse transcription-polymerase chain reaction was used to detect BRCA1 mRNA expression. BRCA1 expression was correlated with age, histological type and grade of breast cancer, estrogen and progesterone receptor status, and C-erbB-2 expression. No demonstrable BRCA1 mRNA and protein expression was found in 79 and 83% of the breast cancer tissues, respectively. A positive relationship was demonstrated between lack of BRCA1 [mRNA and protein] expression and high histological grade, negative estrogen and progesterone receptor status, and overexpression of C-erbB-2 in the breast cancer tissues. Conclusions: The study demonstrated lack of BRCA1 gene expression [mRNA and protein] in the majority of breast cancers in Kuwait and confirmed the inverse relationship between BRCA1 expression and parameters that determine poor prognosis in breast cancer

Giant cell arteritis of the breast

To report a rare case of giant cell arteritis of the breast in a 56-year-old woman. Clinical Presentation and Intervention: The patient presented with tenderness in the upper outer quadrant of the left breast, in the absence of any constitutional symptoms. A diagnosis of giant cell arteritis was made only after surgical wedge excision of the affected breast quadrant. She returned 6 weeks later with tenderness in the upper inner medial quadrant of the same breast, with a raised erythrocyte sedimentation rate. She has since been referred to the rheumatologist for further management. The diagnosis of giant cell arteritis of the breast was made only after pathological examination of the excised breast tissue. This study focused attention on the need to be aware of systemic conditions that may present as localised lesions of the breast and to maintain a high index of clinical suspicion in order to adequately investigate them and perhaps avoid unnecessary radical surgical intervention such as mastectomy

Helicobacter pylori-associated chronic antral gastritis in Kuwait- A histopathological study

In order to study the causal relationship between Helicobacter pylori [HP] and various inflammatory reactions in gastric antral mucosa, we have reviewed 268 endoscopic gastric biopsies in the Department of Pathology of Mubarak Al-Kabeer Teaching Hospital in Kuwait. Of the 219 HP-positive biopsies, 95.4% showed chronic gastritis [CG], 59.8% active chronic gastritis [ACG] and 78.5% lymphoid hyperplasia [LH]. The prevalence of LH, CG or ACG, either alone or in combination, increased with increasing density [grade] of HP colonization, assuming statistical significance for LH and ACG [P<0.05], especially when these changes in Grade 1 HP cases were compared to those of Grades 2 and 3 combined. Moreover, the grade of LH by itself also showed statistically significant correlation [P<0.01] with the grade of inflammation. Our results confirm a causal relationship between HP colonization of gastric mucosa and the various forms of gastritis, and also provide evidence in support of induction of mucosa-associated lymphoid tissue [MALT] by HP, an observation which may have significance in the genesis of gastric MALTomas

Breast cancer in a teaching hospital in Saudi Arabia

Clinical and pathological data of 56 cases of breast cancer in our hospital are presented. Our impression of low case incidence of the disease has been confirmed, even though breast cancer ranks highest of all female malignancies in Saudi Arabia. The disease is common in younger age groups, with over half of the cases presenting late and with advanced disease [Stage III or IV]. Pain as a presenting symptom appeared unusually frequently in this study and possible causes of this pain are discussed

Atrophic gostnitis and intestinol metaplona in helicobocter pyloi-amocioted antrol gostnitis

Although the causal relationship between Helicobacter pylori [H. pylori] infection and chronic gastritis and peptic ulcer disease appears established, the relationship between the organism and gastric carcinoma remains tenuous. We have reviewed 268 gastric antral biopsies from the Department of Pathology, Mubarak Al-Kabeer Hospital, Kuwait, in an attempt to assess the relationship between H. pylori colonizations and the presence of atrophic gastritis and intestinal metaplasia, recognized premalignant lesions of the stomach. H. pylori were found in 219 [81.7%] patients of which 62 [28.3%] had atrophic gastritis and 33 [15.1%] intestinal metaplasia. Both atrophic gastritis and intestinal metaplasia increased with age. The mean age of patients with intestinal metaplasia was about 8 years older than that of patients without intestinal metaplasia. Higher prevalences of both lesions were associated with lower density H. pylori colonization as well as an increasing grade of chronic inflammation. Our results confirm previous findings of a probable causal relationship between H. pylori infection and both atrophic gastritis and intestinal metaplasia. The higher prevalence of these premalignant lesions in older subjects would suggest progressive changes associated with persistent H. pylori infection