Adrenal Mass in Patients who Underwent Abdominal Computed Tomography Examination.

BACKGROUND: Adrenal masses are usually discovered incidentally (IAM) during abdominal computed tomography (CT). AIMS: We aimed to describe the prevalence, management, and outcome of incidentally discovered adrenal mass on radiological investigation. MATERIALS AND METHODS: A retrospective analysis was conducted to look for IAM identified by abdominal CT performed for other reasons between 2004 and 2008 and were followed for 4 years. IAM patients with known malignancy or clinically evident adrenal disease or overt disease originally missed due to insufficient clinical examination were excluded. RESULTS: A total of 13,115 patients underwent abdominal CT, of which 136 were identified with adrenal mass (69 males and 67 females). Overall, 84 patients had benign IAM and six had primary adrenal carcinoma (all had tumor size ≥4 cm and five were males). Hormonal evaluation was performed in 80 cases, which revealed hypersecretion in 10 cases (six had Conn's syndrome and four had pheochromocytoma). Males had higher frequency of right-sided IAMs; whereas, left-sided IAM swere more common among females (P = 0.02). Seven patients underwent surgery and all were males (one Conn's syndrome, one pheochromocytoma, three primary adrenal adenocarcinoma, one benign nonfunctional adenoma, and one metastatic tumor). Only one patient died due to brain metastasis. CONCLUSION: The overall prevalence of adrenal incidentaloma is 1% in Qatar. Unfortunately, hormonal evaluation, surgical referral, and follow-up are not appropriate in this study. Moreover, screening of IAM warrants more attention to rule out malignancy. This work could be of value as a local auditing for the current management.

Clinical presentation, management, and outcome of patients with incidental renal angiomyolipoma in qatar.

OBJECTIVES: Our study aimed to analyze the clinical presentation, management, and outcome of renal angiomyolipoma patients incidentally detected upon computed tomography (CT) examination. METHODS: Between 2004 and 2008, all patients who underwent abdominal CT examination for any reason at the radiology department at Hamad General Hospital, Qatar were retrospectively reviewed. The diagnosis of renal angiomyolipoma was based on abdominal CT evaluation. Angiomyolipoma patients were followed-up by CT evaluation as per standard care for three years to observe any change in size and outcome. RESULTS: A total of 13,115 patients were screened, of which 56 (40 females and 16 males) had renal angiomyolipoma. The mean age of patients was 52±13 years with 46% Qatar nationals. The majority (95%) of cases had unilateral tumors (52% right-sided and 43% left-sided). Twenty-six cases showed increase in tumor size and the median increase was 0.5cm (0.1-3.6). Surgical intervention was required in four (7%) cases with tumor size ≥4cm. The overall mortality on follow-up was 7%. The cause of death included metastasis, renal failure, hepatic failure and mesenteric thromboembolism. CONCLUSION: Renal angiomyolipoma is an uncommon benign tumor with an overall prevalence of 0.4% in Qatar. It has characteristic clinical features and its recognition is often challenging for proper clinical diagnosis and treatment in asymptomatic patients. Asymptomatic patients need regular radiological surveillance. In contrast, surgical interventions are mainly required in symptomatic patients with increased tumor size (≥4cm). Timely diagnosis and treatment is necessary to avoid complications such retroperitoneal hemorrhage and renal impairment.

Gastric antisecretory and antiulcer activity of bovine hemoglobin.

AIM: To investigate gastric antisecretory and gastroprotective activity of bovine hemoglobin (B-Hb) in rats. METHODS: Adult Albino-Wistar rats were divided into groups of 6 animals each. B-Hb in doses of 100, 300 and 900 mg/kg body weight was tested for gastric acid secretion and antiulcer activity. Gastric secretions were measured 6 h after pylorus ligation in rats pretreated with B-Hb. The acidity was measured by titrating gastric contents against 0.01 mol/L NaOH to pH 7. Indomethacin ulcers were produced by oral administration of 30 mg/kg bw in the rats pretreated with B-Hb one hour before indomethacin. Six hours after indomethacin stomach removed and ulcer index was recorded. Ethanol ulcer were produced by 1 mL of ethanol in the rats pretreated with B-Hb 30 min before the ethanol. One hour after ethanol stomach were cut open to score ulcers. Histological examination and analysis of gastric wall mucus, non-protein sulfhydryl groups (NP-SH), and myeloperoxidase (MPO) were carried in gastric tissue following ethanol administration. RESULTS: In control rats pylorus ligation for 6 h resulted in the accumulation of 8.1 ± 0.61 mL of gastric secretion. The treatment of the rats with 100, 300 and 900 mg/kg of B-Hb produced a significant decrease in the volume of gastric secretion 5.6 ± 0.63, 5.5 ± 0.75 and 4.7 ± 0.58 mL respectively as compared to the control group [analysis of variance (ANOVA) F = 4.77, P < 0.05]. The lesion area in the control group was found to be 22.4 ± 3.2 mm(2) six hours after the administration of indomethacin. Treatment of rats with B-Hb at doses of 100 mg/kg (24.3 ± 3.29 mm(2)), 300 mg/kg (16.2 ± 1.45 mm(2)) and 900 mg/kg (12.6 ± 1.85 mm(2)) produced a dose dependent decreased the lesion scores (ANOVA F = 4.50, P < 0.05). The ulcer index following one hour after 1 mL ethanol was 7.1 ± 0.31. Pretreatment of rats with B-Hb at the doses of 100 mg/kg (2.5 ± 0.42), 300 mg/kg (2.1 ± 0.4) and 900 mg/kg (0.7 ± 0.21) significantly inhibited the formation of gastric lesions (ANOVA F = 63.26, P < 0.0001). Histological examination of gastric mucosa following ethanol showed significant lesions in the form of gastric pits with detachment of the surface epithelium; vacuolation of epithelial cells and elongation of microvessels. The changes were dose-dependently attenuated by B-Hb. The treatment of rats with ethanol significantly decreased the Alcian blue binding capacity of gastric wall mucus (480 ± 25.6 µg Alcian blue/g of tissue) as compared to control rats (667 ± 25.8 µg). Pretreatment of rats with B-Hb at the doses of 100 mg/kg (516 ± 31.6 µg/g), 300 mg/kg (558 ± 28.8 µg/g) and 900 mg/kg (654 ± 33.8 µg/g) significantly attenuated ethanol induced depletion of gastric wall mucus (ANOVA F = 8.05, P < 0.005). A significant and dose dependent increase of gastric mucosal NP-SH (ANOVA F = 19.62, P < 0.001) and decrease in MPO activity (ANOVA F = 3.1, P < 0.05) was observed in B-Hb treated rats. CONCLUSION: B-Hb possesses significant gastric antisecretory and gastroprotective activity against experimentally induced gastric lesion. The gastroprotective effects of B-Hb are accompanied by inhibition of neutrophils activity, reduction of oxidative stress and maintenance of mucosal integrity.

Non-surgical management in 336 patients of hydatid disease: 23 years experience at Riyadh Military Hospital.

BACKGROUND/AIMS: Patients with hydatid cysts (336) were studied at Riyadh Military Hospital, Saudi Arabia, between February 1985-June 2008, out of which 254 patients underwent non-surgical management and 82 patients had surgery. METHODOLOGY: Drug therapy was administered to 194 of 254 patients: albendazole was administered in 65 patients; (albendazole+praziquantel) in 129 patients; 12 patients had endoscopic management; 48 patients had Percutaneous-Aspiration-Injection-Reaspiration (PAIR) and 82 patients had surgery. RESULTS: Out of 65 patients, 34 had completed albendazole of which 12 (35%), had cyst disappearance, 8 patients had partial cyst reduction, 12 had no response and were referred for combined therapy or PAIR; 66 patients with cysts in different organs completed the study using albendazole+praziquantel, in 50% of these cysts had disappeared and 16 (24%) observed reduction of cysts; 48 patients underwent PAIR, of which in 36 cysts (66.66%) disappeared; 82 patients had surgery and 20% had post-surgical complications. CONCLUSION: A great advance recently has happened in the non-surgical management of hydatid cysts including medical, PAIR and endoscopic management, which has led to a significant reduction in the need for surgical intervention.

Transient sinus node dysfunction with acute hepatitis of unknown etiology.

We reported a case of a 72-year-old male, known diabetic on insulin, referred because of complete atrioventricular block. He was found to have acute hepatitis during which he developed transient atrial arrhythmia, and sinus node dysfunction. His cardiac symptoms disappeared completely after hepatitis improvement. All of his cardiac investigations were normal including electrocardiogram, echocardiography and thalium stress test. At 3 and 6 months follow up, his Holter monitoring did not show any further arrhythmia, and he denied any further episodes of palpitation or pre-syncope. We reviewed the literature regarding the relationship between hepatitis and atrial arrhythmia.