Traumatic diaphragmatic hernia: an Asir region (Saudi Arabia) experience.

Ten patients (nine males, one female), seen at the Asir Central Hospital of South-Western Saudi Arabia with proven traumatic diaphragmatic hernia between 1987 and 1997, were reviewed retrospectively. The mean age was 29.6 years, range 5 to 50 years. Chest pain and vomiting were the commonest symptoms. Blunt trauma (road traffic accident--5, fall from height--1, (accounted for 60% of the cases) while gunshot wound and stab wounds were the causes in two patients each. The chest radiograph suggested the diagnosis in all the cases. Barium meal (in two patients) and barium enema (in two patients) complemented the diagnosis. Computed tomography (CT) scan was done in only one patient. Thoracotomy (in 2 patients), laparotomy (in 5 patients) and thoraco-laparotomy (in 3 patients) were the surgical approaches to management. Common herniated organs were liver, stomach, spleen and large bowel. The injuries were on the left side in seven patients and on the right side in three cases. Immediate surgical repair was done in four patients while it was done two days to four years later in others. Complications were minimal and there was only one death.

Bochdalek hernia in adulthood: a case report and review of recent literature.

A 37-year-old Filipino woman presented with a post road-traffic accident fracture of dorsal spine 12. Chest radiograph revealed evidence of loops of small bowel in the left lung field. She admitted to symptoms of respiratory insufficiency since birth and treatment for tuberculosis in childhood. A pre-operative diagnosis of left traumatic diaphragmatic hernia was not confirmed at laparotomy which revealed typical left congenital Bochdalek hernia with smooth edges and herniation of small bowel and spleen into the left pleural cavity. Following reduction and repair of the hernia, the patient made an uneventful recovery. Chest radiograph remains normal till now, eight years post-operatively.

Diffuse pulmonary calcinosis and multiple soft tissue calcification in renal failure patient with pathological femoral fracture.

The rare occurrence of diffuse pulmonary calcinosis is described with case illustration of a patient who presented with a pathological femoral fracture during end-stage renal failure. Associated metastatic soft tissue calcification with parathyroid hyperplasia requiring parathyroidectomy was observed. Roentgenologic evidence of hyperparathyroidism with osteitis fibrosa cystica and a high product of the calcium and phosphate values were indications for the parathyroidectomy. Recent literature review of pulmonary calcinosis and multiple soft tissue calcification is also presented.

Bronchial carcinoid tumours in southern Saudi Arabia.

Clinical presentation, pathology, surgical management and follow-up of ten bronchial carcinoid tumour (BCT) patients are described. There were five male and five female patients with age range between 5 to 85 years (mean 39.2 +/- 21.5, SD). Pathology revealed BCT on the right side in seven and on left side in three patients. The tumour was an incidental finding in four while the other six had respiratory symptoms. Cough was present in all of the later group and hemoptysis was present in four patients. Recurrent chest infections were seen in two patients. Symptoms ranged from 1 week to 15 years. Successful surgical resection was done in nine with the longest follow-up of 80 months (mean: 23 months +/- 26.3, SD) without recurrence or metastasis. Histopathological examination of these tumours revealed classical morphological features in all but one case. Grimelius stain positivity for argyrophilia confirmed the diagnosis in all the patients in this study. Electron microscopic examination was done in patient no. 9 which showed atypical morphological features and neurosecretory granules. BCT may present like pneumonias or bronchial asthma. Although BCTs have low-grade malignancy, early diagnosis and surgical resection yield curative results almost in all cases.

Unusual presentations of injury to the bronchus with literature review.

Two patients with unusual presentation of injury to the bronchi are discussed. The first had a gun shot wound of the anterior left chest with the bullet ricocheting across to the right hemithorax and puncturing the right mainstem bronchus resulting in right massive pneumothorax and subcutaneous emphysema. The second suffered a blunt thoracic trauma from a road traffic accident and presented with bilateral rib fractures and bilateral pneumothoraces treated with bilateral closed thoracostomy tube drainage. Bronchofiberscopy revealed complete transection of the left mainstem bronchus.