Insulinoma in Saudi Arabia: a twenty-year hospital study.

The study was designed to assess retrospectively clinical pattern of insulinoma at a national referral center in the Kingdom of Saudi Arabia. All cases of insulinoma recorded at King Khalid University Hospital Riyadh between January 1987 and December 2006 were reviewed. During the 20-year period five patients were seen comprising three females (ages 38, 40, and 70 years) and two males (17 and 34 years). The duration of symptoms prior to diagnosis ranged between one and eight years. The commonest mode of presentation before diagnosis was inability to observe Ramadan fasting. Other notable symptoms included dizziness and loss of consciousness. All the five patients proceeded to operation. At surgery all were found to be benign tumors. Post-operatively, three of the patients developed pseudocyst, which resolved upon undergoing second surgery. Though clinical presentation of insulinoma in Saudi subjects is similar to those reported in the literature, our study revealed prominent symptoms occurring during yearly ramadan religious fast could be a useful information in history taking. Further studies on a larger population are needed to further characterize our findings.

Insulinoma in Saudi Arabia: a twenty-year hospital study.

The study was designed to assess retrospectively clinical pattern of insulinoma at a national referral center in the Kingdom of Saudi Arabia. All cases of insulinoma recorded at King Khalid University Hospital Riyadh between January 1987 and December 2006 were reviewed. During the 20-year period five patients were seen comprising three females (ages 38, 40, and 70 years) and two males (17 and 34 years). The duration of symptoms prior to diagnosis ranged between one and eight years. The commonest mode of presentation before diagnosis was inability to observe Ramadan fasting. Other notable symptoms included dizziness and loss of consciousness. All the five patients proceeded to operation. At surgery all were found to be benign tumors. Post-operatively, three of the patients developed pseudocyst, which resolved upon undergoing second surgery. Though clinical presentation of insulinoma in Saudi subjects is similar to those reported in the literature, our study revealed prominent symptoms occurring during yearly ramadan religious fast could be a useful information in history taking. Further studies on a larger population are needed to further characterize our findings.

Impact of clinical and histopathological factors on outcome of Egyptian patients with crescentic glomerulonephritis.

This study included 128 patients with crescentic glomerulonephritis (CGN) having sufficient clinical and histopathological data and were followed up in our institute for a mean period of 34 +/- 28 months. There were 49 males and 79 females with mean age 22.7 +/- 14 years. We studied the effect of clinical, laboratory and histopathological parameters on kidney function and patient survival at the end point of the study. The multivariate analysis revealed that serum creatinine at presentation, nephrotic range proteinuria during the follow up period, percentage of glomeruli affected by crescents, percentage of fibrous crescents and absence of cellular infiltration were significant risk factors affecting the kidney function at termination of the study. The only risk factor which correlated significantly with the patient mortality was the serum creatinine at last follows up.

Role of penile vascular insufficiency in erectile dysfunction in renal transplant recipients.

The objectives of this study were to define the role and haemodynamic features of penile vascular insufficiency in impotent renal transplant recipients (RTR) as well as to establish the possible vascular risk factors for impotence in these patients. A total of 54 RTR (35 impotent and 19 potent) and 21 potent healthy subjects were included in this study. All patients were assessed clinically and by measurement of serum creatinine, serum bilirubin, cyclosporine blood levels, haemoglobin and total serum cholesterol. All subjects were subjected to intracavernous injection of 20 microg prostaglandin E1 followed by colour Duplex sonographic examination. Our results showed that impotent RTR were significantly more likely than potent RTR to have hypertension, diabetes and hypercholesterolaemia (P<0.05). Arterial occlusive disease was identified in 42.9% of impotent RTR. Findings suggestive of veno-occlusive dysfunction were found in 68.6% and 26.3% of impotent and potent RTR, respectively (P=0.003). Unilateral ligation of the internal iliac artery has a negative role on haemodynamic parameters compared to unilateral end-to-side anastomosis to external iliac artery in impotent RTR (P<0.05). Impotent RTR receiving more than one antihypertensive drug showed significant decrease in basal peak systolic velocity (PSV), dynamic PSV, erectile angle and cavernosal artery diameter compared to those receiving one drug (P<0.05). In conclusion, penile vascular insufficiency appears to play a substantial role in the pathogenesis of impotence in transplant patients. Anastomosis of the graft to external iliac artery could preserve the potency to some degree. Antihypertensives should be reduced as much as possible to avoid their negative effects on erectile function.

Effect of midgut bacteria of Culex pipiens L. on digestion and reproduction.

An investigation was carried out to evaluate the influence of symbiotic bacteria associated with Culex pipiens L. on pre-oviposition and blood meal digestion periods, and reproductive potential (fecundity and fertility). Aposymbiotic females were obtained by feeding the normal females on 10% sucrose solution mixed with antibiotic (Tarivid) for three days before feeding them on normal blood meals from a pigeon host. A total of 4 genera were previously isolated from the midgut of C. pipiens. These genera were: Bacillus, Streptococcus, Staphylococcus, and Salmonella and Shigella. It seems that the period of blood meal digestion preceded the pre-oviposition period of both bacterial free females and bacterial-free females treated with one of the aforementioned bacteria. In addition, it is obviously clear that, the presence of the two bacterial genera: Bacillus and Staphylococcus in the midgut of C. pipiens is essential for normal and high fecundity. Generally, it is evident that the symbionts (gut bacteria) are essential for the completion of embryonic development.

Primary hyperparathyroidism and pregnancy.

OBJECTIVE: The coexistence of primary hyper-parathyroidism and pregnancy is very rare worldwide. It carries serious complications to the mother and fetus, therefore, early diagnosis and management is of paramount importance. METHODS: Over a period of 16 years from 1982-1997, 24 patients with primary hyperparathyroidism were identified from the central diagnostic index data base of King Khalid University Hospital. Out of these, only 3 women with primary hyperparathyroidism complicating pregnancy were identified. RESULTS: All 3 women were in the fourth decade. Two of them had coexisting vitamin D deficiency with initially normal serum calcium and were misdiagnosed as cases of osteomalacia while the third had very high serum calcium on first presentation. A single parathyroid adenoma was identified in all 3 patients with 2 undergoing surgical removal of the adenoma. The third patient unfortunately had an abortion. The babies of the first 2 patients were born healthy with no complications. CONCLUSION: Primary hyperparathyridism, even though rare in pregnancy, carries risks to the mother and fetus and therefore early screening for asymptomatic hyper-parathyroidism in all women of childbearing age and in the early antenatal period of pregnant women is recommended.

Primary hyperparathyroidism: King Khalid University Hospital Experience.

BACKGROUND: This study was conducted to examine the prevalence, mode of presentation and management of primary hyperparathyroidism in one of the major hospitals in Saudi Arabia. PATIENTS AND METHODS: This was a retrospective analysis of 24 cases of primary hyperparathyroidism, comprising 21 females and three males, who were seen at King Khalid University Hospital over a period of 16 years from 1982 until December 1997. RESULTS: The prevalence of the disease was estimated to be 11.34 per 100,000 hospital population. The majority of the patients presented with musculoskeletal complaints (62%-67%) and/or renal complications (58%). Hypercalcemia was seen in 92% of the cases. Serum PTH was available for 21 patients and 20 had significantly elevated levels. Fifty percent of the patients had features of hyperparathyroid bone disease on plain x-ray, while 79% showed osteopenia of the femoral neck on dual x-ray absorptiometry, and almost all the patients had lumbar osteopenia. Fifty percent of the patients had features of metabolic bone disease on bone scan. Thalliumtechnetium subtraction studies proved to be the most reliable tool, with 83% sensitivity, followed by ultrasound scan of the neck, with a sensitivity of 55%. CT scan of the neck was attempted in only seven patients (29%), with a sensitivity of 86%. Twenty-one patients (87.5%) underwent surgical exploration and removal of the parathyroid adenoma. Single parathyroid adenoma was identified in 85% of the cases, 5% had multiple adenomas, and 5% had hyperplasia of the parathyroid gland. CONCLUSION: Our results showed that primary hyperparathyroidism is not a rare disease in Saudi Arabia. It has a tendency for late presentation with complications. We believe that routine screening for calcium and early identification of such cases are warranted to reduce the morbidity of this easily treatable disorder.

Prospective randomized study of azathioprine versus cyclosporin in live-donor kidney transplantation.

A total of 112 recipients of haploidentical live-related donor kidney transplants were assigned randomly prior to transplantation to two groups of immunosuppressive treatment. The first group (54 patients) received the conventional immunotherapy of azathioprine (AZA) and prednisolone (P; AZA-P group). In the second group, 58 patients were given cyclosporin (Cs) and P (Cs-P group). All patients had previous third-party blood transfusions. The follow-up period ranged from 3 to 6 years (mean 50 +/- 8 months) during which 13 patients (24%) in the AZA-P group and 6 (10%) in the Cs-P group were switched to the alternate immunotherapy (p > 0.05). Analysis of patient and graft survival along the follow-up period did not disclose significant differences between patients of the two groups. While the overall frequency of acute rejection episodes was not significantly different between the two treatment groups, the number of patients who had 2 or more rejection episodes was higher in the AZA-P group (p < 0.04). The mean serum creatinine levels were significantly higher in the Cs-P group than corresponding levels in the AZA-P group at 1, 12 and 24 months after transplantation. We have concluded that at least 75% of the haploidentical human lymphocyte antigen mismatched live-related donor renal transplants can be maintained on AZA-P immunotherapy with a comparable degree of success to those treated with Cs-P. However, in at least 15% of patients with conventional immunotherapy, Cs could reverse ongoing rejections, and therefore, it can be considered as a rescue treatment in AZA-treated patients with steroid-resistant or ongoing rejections.

Cyclosporin in primary haploidentical live-donor kidney transplantation: is it worthwhile?

Two consecutive prospective randomized trials were performed to study three immunosuppressive protocols in 195 kidney transplant recipients. Only adult primary renal transplant recipients with one haplotype HLA mismatch were included. All patients received kidneys from living related donors and had previous donor non-specific blood transfusions. Study I included 112 recipients who were randomly assigned to receive either azathioprine (Aza) and prednisolone (P) (n = 54) or cyclosporin (CsA) and P (n = 58). Patients in this study were followed up for 3-6 years (mean 50 +/- 8 months). Study II included 83 recipients who were randomly assigned to receive either triple therapy of Aza-CsA-P (n = 41) or conventional therapy of Aza-P (n = 42). Patients in this study were followed up for a period of 32 +/- 10 (range 26-43) months. Analysis of data in the two studies demonstrated the absence of statistically significant differences in graft or patient survival rates over short- and long-term follow-up periods among recipients of the conventional immunotherapy and those receiving the CsA-P or the triple therapy. The overall frequency of acute rejection episodes was not significantly different between the two treatment groups of each study. Serum creatinine was significantly higher in the CsA-P group while the incidence of infection was significantly lower in the triple group. When switching from one regimen to another is considered, at least 75% of the one-haplotype HLA mismatched live-related donor renal transplants could be maintained on conventional immunotherapy with comparable degree of success to those treated with the CsA-P or the triple therapy. However, in at least 15% of patients with conventional immunotherapy, CsA could reverse ongoing rejections and can therefore be considered as a rescue treatment.

Effectiveness of the non-steroidal ecdysone mimic, RH-5849 for the control of Musca domestica vicina.

The new non-steroidal ecdysone mimic, RH-5849 (1, 2-benzoyl-1-tert-butylbenzohydrazine) was investigated, its biological actions were evaluated in the laboratory against a susceptible strain of Musca d. vicina. The larvae of 1-day old and of 4-day-old were fed on diets treated with different concentrations of the compound. RH-5849 shortened the larval and pupal durations and induced the initiation of premature lethal moult. The pupation rate was highly affected, where it was reduced to 46.7% at a concentration rate of 250 ppm. Also, the adult emergence was drastically blocked by the action of RH-5849 where its percentage was decreased to 42.9 at 250 ppm. In regard to the fecundity and egg viability, RH-5849 induced a cessation of oviposition in females produced from 1-day-old and from 4-day-old larvae fed on diets treated with 160 and 200 ppm, respectively. In addition, RH-5849 halted the larval and pupal growth, where the untreated pupae were generally heavier than those produced from treated larvae.