Extra-adrenal retroperitoneal ganglioneuroma

Ganglioneuromas are benign tumors that originate from primordial neural crest cells. We report a retroperitoneal ganglioneuroma arising from the left paraspinal region. A twenty-year old woman presented with left lumbar pain. Neurological workup was normal. Imaging revealed a left paraspinal retroperitoneal mass measuring 9.74 x 6.19 x 4.30 centimeters. Complete surgical removal was uneventful. During follow-up, left lumbar pain improved and imaging showed no evidence of the disease

Tracheal injury during oesophagectomy – incidence, treatment and outcome.

Background and aim: Iatrogenic tracheal injuries are uncommon, potentially lethal and associated with significant morbidity. In this report we analyze the incidence of iatrogenic tracheobronchial injuries sustained during oesophagectomies and the results and outcome of repair using a pedicled intercostal muscle flap. Methods: A retrospective analysis was done on all patients who underwent an oesophagectomy between June 2000 and May 2011. Data was collected from an electronic database and the medical records of patients, maintained at our hospital. Results: One hundred and fourteen patient records were analyzed. There were 85 male and 29 female patients. Their mean age was 47 years (range 16 to 86 years). Forty two (36%) underwent a transhiatal oesophagectomy, 34(31%) Mckeown’s oesophagectomy, 35(31%) Ivor Lewis oesophagectomy and 3(2%) thoracoscopy assisted oesophagectomy. Of the 114 oesophagectomies, 86 (75%) were performed for malignant and 28 (25%) for benign pathologies (benign tumors and corrosive strictures of the esophagus). In our study, four patients sustained injury to the tracheobronchial tree during oesophagectomy. In patients who sustained injury during a transhiatal dissection a right anterolateral thoracotomy was made. All injuries in the thoracic tracheobronchial tree were repaired primarily and reinforced with an intercostal muscle flap. In the patient with injury to the cervical part of the trachea, repair was done primarily and reinforced with cyanoacrylate glue. All patients who sustained injury had malignancy and three patients had received neoadjuvant chemoradiotherapy. Two patients sustained injury during transhiatal oesophagectomy and two during a Mckeown’s oesophagectomy. There was one mortality which was due to ventilator associated pneumonia and related complications. The remaining three were alive with no evidence of repair breakdown. Conclusions: Iatrogenic tracheal injuries are uncommon complications but associated with significant morbidity. Preoperative chemoradiotherapy and malignancy are risk factors for iatrogenic tracheal injuries. Reinforcement of the suture line with a muscle flap is an effective technique of repair. Prompt ontable identification and adequate surgical treatment is necessary for a good outcome.

Malignant phyllodes tumor of the breast metastasizing to the peritoneal cavity

A fifty-three year old Bahraini female presented with painless rapidly growing mass in the right breast of 3 months duration; no nipple discharge was found. Family history was positive for breast carcinoma in situ in her sister. Lumpectomy was performed. Histopathology proved to be phyllodes tumor; therefore, mastectomy was performed to avoid local recurrence. The patient received local radiation to the mastectomy scar. Four months after the initial surgery, she developed a nodule in the mastectomy scar, left breast lump in the upper outer quadrant and intra-abdominal mass. A fine needle aspiration of the mass in the left breast showed spindle cells with focal atypia and a necrotic background. True-cut biopsy of the intra-abdominal mass showed the metastatic stromal component of the malignant phyllodes tumor with malignant spindle cells. The patient condition worsened, developed bilateral pleural effusions. Adriamycin chemotherapy was planned, but the disease was aggressive enough to end her life within weeks

Management of primitive neuro-ectodermal tumor of the vagina in a sickle cell disease patient

A twenty-five years old female, a known case of sickle cell disease, presented with frequent and heavy periods of six months duration. Pelvic ultrasound and MRI showed a vaginal mass pushing the bladder anteriorly; the diagnosis of cervical fibroid was considered. Histopatholgical examination of the mass revealed a very rare entity of primitive neuro-ectodermal tumor of the vagina. This is the first recorded patient of sickle cell disease with primitive neuro-ectodermal tumor of the vagina. The management was challenging in dealing with her disease and preserving her fertility

Villonodular synovitis of left knee joint: role of external radiotherapy

We report a case of villonodular synovitis of left knee joint treated with surgery and adjuvant postoperative external radiotherapy. The patient presented with long standing history of left knee joint swelling and pain which restricted his daily activities. He did not get relief with pain killers. The patient was operated for maximal excision of synovial tissue. Histology confirmed the diagnosis of villonodular synovitis. Postoperative left knee joint MRI showed residual disease. He received adjuvant external beam radiotherapy. Currently, he is free of disease and disability after four years

Preliminary screening of pharmacological activities of E-3 arylidene flavanones

Objective of the present study was to synthesize E-3-arylidene flavanones by one pot method and screen their analgesic, anti-oxidant and anti-bacterial activities. A set of four E-3 arylidene flavanones were synthesized by simple base catalysed condensation of appropriate aryl aldehydes and 2'4'dihydroxy acetophenone. Screened analgesic activity by hot plate method, anti-oxidant activity by spectrophotometric method and anti-bacterial activity by cup-plate method. Result showed all four synthesized compounds were found to exhibit reliable degree of analgesic activity and antioxidant action produced by the synthesized compounds were in reverse order to that of analgesic activity. A few of synthesized compounds showed activity against some organisms. Even though all synthesized compounds have same basic nucleus, biological activities expressed by different compounds are not same. Due to structural similarity with those of natural flavanones, all the synthesized compounds were expected to exhibit analgesic activity, but only three were found to exhibit analgesic action. But all showed a reliable degree of anti-oxidant activity. In anti-bacterial studies unsubstituted compound didn't showed any kind of antibacterial activity against any of the tested organisms

Gastric leiomyosarcoma: first case report from the Kingdom of Bahrain and review of literature

Gastric leiomyosarcoma are very rare tumors. We are reporting the first case of gastric leiomyosarcoma diagnosed in Bahrain and documented in the cancer registry. Unfortunately, the patient died due to rapidly progressing nature of the disease despite the multimodality treatment

Fulminant amebic colitis a life threatening rare entity

To present two uncommon cases of Fulminant Amebic Colitis. Retrospective study. Surgical and Medical Department at Salmaniya Medical Complex. From March to September 2008, two cases of fulminant Amebic Colitis were seen and reviewed as far as their presenting features, investigation, characteristic histopathologic picture, and management. Two cases of Amebic Colitis were found in the hospital records during the last ten years. Both presented to the clinic within the last six months. Both patients were males, young, from poor socio-economic class and are originally from Indian subcontinent. Both had vague and mild presentation. One progressed to massive lower GI bleeding and the other one progressed to colonic perforation and peritonitis. The second case had CT scan, which showed signs of colitis and suspected perforation but was not diagnostic of Amebic Colitis. The first case had subtotal colectomy and primary anastomosis; while, the second case had limited colectomy with proximal colostomy and distal mucus fistula. The diagnosis was based on histopathology of the resected specimens. Serology was confirmatory in only one patient. Fulminant Amebic Colitis is a rare entity. Clinical awareness and early surgical intervention are very important in the outcome. Two cases of fulminant Amebic Colitis have been managed by colonic resection of the affected part, in addition to Metronidazole and broad-pectrum antibiotic

Cerebral toxoplasmosis in an HIV positive patient: a case report and review of pathogenesis and laboratory diagnosis

Toxoplasmosis is a worldwide infection. It may have acute or latent clinical presentations. Because of defective cell mediated immunity, patients are at a higher risk of developing toxoplasma encephalitis. We report the first biopsy diagnosed case of cerebral toxoplasmosis in an HIV positive patient from the Kingdom of Bahrain and review the pathogenesis, pathology and laboratory diagnosis

Pseudo-angiomatous stromal hyperplasia: benign tumor of the breast

Pseudo-angiomatous stromal hyperplasia [PASH] is a rare benign tumor of the breast which poses a clinical challenge in distinguishing it from malignancy. We are reporting a young married woman, who presented to the clinic with right breast painless large lump. The patient was managed surgically. Fine needle aspiration-cytology did not confirm the diagnosis. The final diagnosis was arrived at through histopathology

Simultaneous estimation of atorvastatin and ramipril by RP-HPLC and spectroscopy

A number of analytical methods were reported for the estimation of atorvastatin and ramipril from their individual dosage forms or in combination with other drugs [Valiyare, 2004; Vachareau and Neirinck, 2000]. Here successful reverse phase-high performance liquid chromatographic method and spectroscopic methods developed then validated for the analysis of combined dosage form of atorvastatin and ramipril. Individual beta-max for atorvastatin is 247 n.m and that of ramipril is 208 n.m. They intercept at 215 n.m which is fixed as wavelength for reverse phase-high performance liquid chromatographic method

Primary oral tuberculosis: report of two cases.

Oral lesions of tuberculosis though uncommon, are seen in both the primary and secondary stages of the disease. In secondary tuberculosis, the oral manifestations may be accompanied by lesions in the lungs, lymph nodes, or in any other part of the body and can be detected by a systemic examination. Primary oral tuberculosis may present as a diagnostic challenge for the clinician. Here we report two patients with primary tuberculosis in the oral cavity who presented to the dental department, were diagnosed and referred for medical management.

Retroperitoneal leiomyosarcoma infiltrating the inferior vena cava (IVC)--a case report.

Retroperitoneal soft tissue sarcomas are difficult to treat because the retroperitoneal organs and great vessels are often involved by the time the patients come to a surgeon. We present the case of a 48 year old woman with a retroperitoneal leiomyosarcoma that had infiltrated the IVC and the renal veins.

The abdominal cocoon and an effective technique of surgical management.

The Abdominal Cocoon is a very rare cause of small bowel obstruction. It is caused by encapsulation of the small bowel by a fibrous membrane. This tropical disease, seen in young females, has also been reported in males. This is one of the largest series of the Abdominal Cocoon, with five new patients (3 males and 2 females) being reported. The traditional surgical treatment of choice is by lysis of adhesions. All patients in this case series had small bowel intubation done in addition to adhesiolysis. Although small bowel intubation is an established procedure for various causes of recurrent small bowel obstruction, to our knowledge this is the first report of its use in the management of the Abdominal Cocoon. We report our surgical technique in the management of this rare disease.