Allergic bronchopulmonary mycosis in patients with asthma: period prevalence at a university hospital in Saudi Arabia.

Allergic bronchopulmonary mycosis (ABPM) is a known complication of asthma and can result in progressive lung damage, respiratory failure and death. Asthma is a common disease in Saudi Arabia and until now the prevalence of ABPM has not been investigated. The aim of this study was to estimate the period prevalence of ABPM due to Aspergillus and Candida in patients with asthma. The setting was an outpatient pulmonary clinic at a university hospital in the central region of Saudi Arabia. Two hundred and sixty-four consecutive patients with asthma (150 or 57% females) were evaluated. All patients were screened for ABPM with skin prick test (SPT) using a panel of fungal antigens. Those with positive skin reactions had further clinical, immunological, respiratory and radiological assessment. ABPM was diagnosed by the presence of a minimum of five of the major criteria suggested by Rosenberg in 1977. Of the 264 patients, 62 (23%) had a positive SPT for at least one fungal allergen, of whom 44 (71%) were females (P=0.01). Seven patients (six females) were diagnosed with ABPM due to Aspergillus and (or) Candida species. Therefore, we estimate the period prevalence of ABPM to be 2.7% (95% confidence interval 1.3-5.4%). A. niger was the commonest fungal species isolated in our group. In conclusion, ABPM is not uncommon in Saudi Arabia and females seem to be more at risk. Because asthma is common, physicians need to have high index of suspicion for this disease and pursue the diagnosis with the appropriate tests.

Predictors of radiological sequelae of pulmonary tuberculosis.

PURPOSE: In patients with pulmonary tuberculosis, clinical factors that are associated with poor radiological outcome have not been adequately addressed in the medical literature. The aim of this study was to explore some of these factors in patients admitted to a large chest hospital in Saudi Arabia with pulmonary tuberculosis. MATERIAL AND METHODS: Chest radiographs of 1,080 patients with pulmonary tuberculosis were reviewed. Post-treatment residual changes were classified from 1 to 5 according to the severity of these changes. Data analysis was done by tabulating these classes against different variables that were likely to influence the final radiological appearance at the end of the treatment period. RESULTS: Near-complete or complete clearance of chest radiography (Class 1) was seen in 43.5% of patients <20 years old compared to 30.3% in patients > 40 years old (p < 0.05). The latter group also had significantly higher rate of pleural thickening (9.4% vs. 3.6%), higher rate of fibronodular densities (24.9% vs. 19.5%) and higher rate of persistent cavitation (18.3% vs. 11.9%). Females had a significantly lower rate of chest radiography clearance (30.5%)) than males (41.4%). Patients with a duration of respiratory symptoms of <4 weeks had 45.2% Class 1 radiography compared to 24.6% for those with longer duration of symptoms (> 8 weeks). Chest radiography clearance was more frequent (51.6%)) in patients with good compliance with drug therapy compared to those with poor compliance (18.8%). Persistent cavitation (Class 5) was seen in 30.4% of cases with a past history of tuberculosis and in only 14% of cases with no such history. CONCLUSION: Old age, female gender, long duration of symptoms (delayed diagnosis), poor compliance with treatment and positive history of tuberculosis were associated with poor radiological outcome.

Allergic bronchopulmonary aspergillosis: disease pattern in central Arabia.

Despite a high prevalence of asthma in Saudi Arabia, allergic bronchopulmonary aspergillosis (ABPA) has not been reported. We reviewed the medical records in a large university hospital in Saudi Arabia where thousands of asthmatics are being followed up. Over a 9-year period starting January 1986, the diagnosis of ABPA was made in 10 patients only. Delay in diagnosis was common and in some patients the disease was confused with fungal pneumonia, tuberculosis or tumours. Aspergillus fumigatus was isolated from one patient only and different Aspergillus species were cultured from respiratory secretions of the others. Corticosteroids were uniformly effective in all patients with active disease. Low humidity may account for this apparent rarity of ABPA, although it is possible that some cases are overlooked. Further work is needed on the prevalent fungi in the Arabian environment and their potential health effects and particularly on the prevalence of allergic bronchopulmonary fungal disease.

The "temporocele".

This article reports a case of spontaneous extracranial pneumatocele and introduces a new simple terminology for this clinical entity. A 10-year-old Saudi girl presented with left tympanoparietomastoid swelling. It was found to be fluctuant and full of air. On exploration, bony septae were found arising from the skull aponeurosis, the cranial boundary was elevated, and an ivory, cancellous bony swelling was over the root of the zygoma. No naked eye anatomic communication to the mastoid air cell was found. The mastoid pneumatization was within normal limits. All preoperative, operative, and postoperative investigations are presented. The authors introduce temporocele as a new term applied to this extracranial spontaneous pneumatocele.

Uncommon scintigraphic findings of multiple hepatic hemangiomas.

Tc-99m labeled red blood cell scintigraphy is a valuable, noninvasive technique for differentiating hepatic hemangioma from other lesions by demonstrating a "perfusion blood pool mismatch." The characteristic finding on dynamic CT scan of peripheral and subsequent central enhancement is not usually seen on Tc-99m RBC angiography, probably due to rapid mixing and dilution of the radionuclide and low resolution of the gamma camera. A case of multiple hepatic hemangioma is presented in which Tc-99m RBC dynamic angiography demonstrated peripheral enhancement with subsequent central filling. In addition, delayed static images showed more hepatic lesions.

Management of post-tuberculous complex aspergilloma of the lung: role of surgical resection.

Of 14 patients with complex aspergilloma complicating healed tuberculosis, 12 underwent lobectomy or pneumonectomy for recurrent haemoptysis. No deaths occurred, though one patient needed re-exploration for bleeding. There was no postoperative worsening of dyspnoea despite a mean forced vital capacity (FVC) of 60% predicted for the patients undergoing surgery and of 20% predicted for two patients with severe restrictive defects, perhaps owing to the fact that there was little or no function in the resected part of the lung, as shown by preoperative isotope ventilation-perfusion scanning, and that patients were under the age of 50 and generally fit. There has been no recurrence of haemoptysis during follow up, which has been from 12 to 33 months. Surgical resection, provided that cases are carefully selected, offers the best chance of cure with low mortality and morbidity.

Fluid-aided sonography of the stomach and duodenum in the diagnosis of peptic ulcer disease in adult patients.

Sixty-five patients with a clinical suspicion of peptic ulcer disease were evaluated with fluid-aided sonography (US). The results were compared with endoscopic and upper gastrointestinal (UGI) series findings. Fifteen normal volunteers were examined by US only. The stomach and duodenum were both adequately visualized in 12 of the normal volunteers and in 51 of the study patients. US detected wall abnormalities in 21 of 23 patients (91%) with abnormal UGI series and endoscopy in the antropyloric and duodenal regions, although none of the 17 documented ulcers were visible by US. Abnormalities detected with US included increased wall thickness (mean, 12.85 mm), asymmetric thickening of the mucosa and muscularis, spasm, and deformity. US was considered normal in 25 of 28 patients (89%) with normal UGI series and endoscopy. The results suggest that US may be a useful nonstressful procedure in the evaluation of peptic ulcer disease previously diagnosed by UGI series or endoscopy.

Immotile-cilia syndrome with azoospermia: a case report and review of the literature.

A case of immotile-cilia syndrome associated with azoospermia is presented. This diagnosis is based on a typical history of bronchitis, sinusitis, situs inversus, impaired nasal mucociliary clearance and characteristic ultrastructural defect in the respiratory tract cilia and in the sperm tail. Semen analysis showed azoospermia with no evidence of obstruction in the epididymis or vas deferens; there was normal spermatogenesis.

Primary cardiac echinococcosis: report of two cases with review of the literature.

Two case reports of Saudi patients with primary cardiac hydatid cysts are presented. In the first case, a multilocular cyst was located in the wall of the left ventricle, whereas in the second case a cyst was located in the pericardial sac and another cyst in the left ventricular wall. The diagnosis was based on a history of animal contact, full clinical examination, serological tests and the use of plain radiography, including conventional tomogram, two-dimensional echocardiography, computed tomography and thallium perfusion isotope scan. This study has indicated that non-invasive radiological methods are sufficient to diagnose cardiac echinococcosis and could provide the same information as, or even more than if invasive techniques were used. Further screening of the two patients showed no involvement of other organs by hydatid cysts.

Value of medium-thickness CT in the diagnosis of bronchiectasis.

The usefulness of CT with 4-mm-thickness cuts at 5-mm intervals in the diagnosis of bronchiectasis was studied by comparing the results of CT with those of bronchography in 323 segmental bronchi in 20 patients. No bronchiectasis was found on either study in 222 segmental bronchi. Of the 101 segmental bronchi showing bronchiectasis on bronchography, CT correctly identified bronchiectasis in 98 segments (97%). Bronchography showed cystic bronchiectasis in 35 and varicose bronchiectasis in 14 segmental bronchi, all of which were correctly identified on CT. Of the 52 segmental bronchi showing cylindrical bronchiectasis on bronchography, CT correctly identified these changes in 49 segments but failed to detect it in three. The presence of interstitial lung disease with emphysema and very localized mild bronchiectasis in one case each made the identification of cylindrical bronchiectasis difficult and caused the false-negative results. When bronchography is used as the criterion, CT with medium-thickness cuts and medium slice intervals appears to be 100% specific for all types of bronchiectasis, 100% sensitive for cystic and varicose bronchiectasis, and 94% sensitive for cylindrical bronchiectasis.

Prevalence of mitral valve prolapse in healthy Saudi women.

Two-hundred-and-thirty-two Saudi young women were prospectively clinically examined for the presence of mitral valve prolapse. Phonocardiograms recorded in all subjects at rest in supine position revealed 10.7% incidence of systolic clicks and/or mid to late systolic murmurs. Echocardiographic studies were performed in supine, left lateral as well as sitting up positions. Twenty-eight subjects were found to have mitral valve prolapse. Of these, 21 subjects had mid to late systolic prolapse when the other seven subjects were found to have pansystolic prolapse (holosystolic). Eight of the 28 positive subjects had auscultatory evidence of mitral valve prolapse. It seems that mitral valve prolapse is more common than expected in healthy Saudi women population.

Tuberculous oesophagopulmonary communication: effectiveness of antituberculous chemotherapy. A case report and review of literature.

A patient with tuberculous oesophagopulmonary communication diagnosed by oesophagography and confirmed by endoscopy was successfully treated by medical means: a tuberculous aetiology was suggested by the detection of tubercle bacilli in the gastric washings and on culture. On reviewing the medical literature, successful results were reported in 3 adults and 2 children.