A Huge Subcapsular Splenic Cyst Like Hematoma in Sickle Cell Anemia.

Nontraumatic splenic rupture and hematoma are rare in sickle cell disease. We present a case of a 22-year-old Saudi male with sickle cell disease. He presented to our hospital with a history of nontraumatic abdominal pain, hemodynamic instability, and abdominal tenderness, with a large mass extending to the umbilicus. A computed tomography (CT) examination showed splenomegaly and a spleen infarction. The patient was admitted to the intensive care unit (ICU) and stabilized. He was transferred to the regular ward and discharged against medical advice (DAMA). Later on, he presented again with persistent abdominal pain. He underwent splenectomy with cholecystectomy. The patient did well postoperatively and was discharged in good condition. While conservative management is common, operative management should be considered in patient with persistent pain. Splenic rupture has a high mortality rate.

Spontaneous Umbilical Hernia Rupture Associated With Omentum Evisceration in a Patient With Advanced Hepatic Cirrhosis and Refractory Ascites.

Flood syndrome is a spontaneous rupture of an umbilical hernia. It has a high mortality and morbidity and presents many challenges in medical versus surgical management. We present a case of a 23-year-old Yamani woman with complicated umbilical hernia, newly diagnosed hepatitis B infection, and decompensated liver cirrhosis with ascites (Child-Pugh grade B). The patient was undergoing multiple abdominal ascitic tapping that eventually ruptured with an omentum evisceration, causing Flood syndrome. An urgent umbilical hernioplasty with mesh in a sublay technique was conducted.

Behavior of primary tracheal glomus tumor, uncertain malignant potential subtype.

The behavior of the pathological subtypes of tracheal glomus tumor (benign, uncertain malignant potential UMP, malignant) is vague. In a 51-year-old gentleman, suffering from cough for 4 months, computed tomography scan showed a mass at lower third of the trachea and the bronchoscope revealed exophytic mass at the tracheal lumen. Segmental tracheal resection was done using special modified endotracheal tube for the distal lung ventilation. The tracheal glomus tumor was also diagnosed based on the immunohistochemical staining. The tumor was 2 cm in diameter, deeply located, mitotic phase was difficult to identify, and a diagnosis of UMP subtype was made. There was no recurrence after 2 years follow-up. This is the first reported case of UMP subtype in lower trachea and we studied the treatment options with the clinic-pathological behavior of this tumor and its sequel by regular follow-up.

Targeting mitochondria by Zn(II)N-alkylpyridylporphyrins: the impact of compound sub-mitochondrial partition on cell respiration and overall photodynamic efficacy.

Mitochondria play a key role in aerobic ATP production and redox control. They harness crucial metabolic pathways and control cell death mechanisms, properties that make these organelles essential for survival of most eukaryotic cells. Cancer cells have altered cell death pathways and typically show a shift towards anaerobic glycolysis for energy production, factors which point to mitochondria as potential culprits in cancer development. Targeting mitochondria is an attractive approach to tumor control, but design of pharmaceutical agents based on rational approaches is still not well established. The aim of this study was to investigate which structural features of specially designed Zn(II)N-alkylpyridylporphyrins would direct them to mitochondria and to particular mitochondrial targets. Since Zn(II)N-alkylpyridylporphyrins can act as highly efficient photosensitizers, their localization can be confirmed by photodamage to particular mitochondrial components. Using cultured LS174T adenocarcinoma cells, we found that subcellular distribution of Zn-porphyrins is directed by the nature of the substituents attached to the meso pyridyl nitrogens at the porphyrin ring. Increasing the length of the aliphatic chain from one carbon (methyl) to six carbons (hexyl) increased mitochondrial uptake of the compounds. Such modifications also affected sub-mitochondrial distribution of the Zn-porphyrins. The amphiphilic hexyl derivative (ZnTnHex-2-PyP) localized in the vicinity of cytochrome c oxidase complex, causing its inactivation during illumination. Photoinactivation of critical cellular targets explains the superior efficiency of the hexyl derivative in causing mitochondrial photodamage, and suppressing cellular respiration and survival. Design of potent photosensitizers and redox-active scavengers of free radicals should take into consideration not only selective organelle uptake and localization, but also selective targeting of critical macromolecular structures.

Fast agar-based urease test for detection of Helicobacter pylori infection in the stomach.

OBJECTIVE: Helicobacter pylori (H. pylori) is an important etiological factor in the development of upper gastro intestinal tract (GIT) conditions. A variety of tests are now available to diagnose H. pylori infection but they require a relatively longer time to yield a definitive result. The present work describes fast agar-based urease (FABU) test for detection of the H. pylori in gastric biopsy. METHODS: One hundred and eighty-seven patients with upper GIT conditions were included in this study for the period from April 2003 to May 2004. One antral biopsy was taken from 100 patients while 2 antral biopsies were taken from 87 patients and inserted into FABU test, in addition to 3-4 biopsies were taken for histology examination. RESULTS: Using one antral biopsy, the FABU test correctly identified 65 of the 78 biopsies positive for H. pylori by histology (83.3%). There were 11 false negative (FN) and 3 false positive (FP). This yields sensitivity of 85.5% and specificity of 87.5%. While when 2 antral biopsies were used, the test correctly identified 61 of 64 H. pylori infected patients (92.2%). There were 3 FP and 5 FN. This yields sensitivity of 92.4% and specificity of 85.7%. Also, the result of this study revealed that 73.2% of the total patients included in this study were infected with H. pylori. Approximately 46.5% were males and 26.7% were females. CONCLUSION: The results of our study indicate that the FABU test is superior to other commercially available urease tests and provides rapid results of H. pylori status even before the patient is discharged from endoscopy suite.