A comparison of histological appearances of Hodgkin's disease in Pakistani and Saudi patients.

BACKGROUND: Hodgkin's disease (HD) is a relatively rare lymphoma that affects younger as well as older persons. It is reported in the Western as well as Asian studies that HD is a rare disease in developing world. It is commoner in males in most of the countries and shows a bimodal pattern of age. The commonest subtype is nodular sclerosis in the west and mixed cellularity in the eastern and developing countries. The present study compares eight years' data of HD as regard age, sex, site of anatomical presentation and subtypes according to WHO classification among Pakistani and Saudi patients. METHODS: This retrospective comparative study included 211 cases of HD from various institutions of Lahore, Pakistan; and 78 cases retrieved from the data of King Abdul Aziz Hospital and Oncology Centre, Jeddah, Saudi Arabia. RESULTS: The analysis of both data of HD showed lack of bimodal age pattern and was common among younger age. Male was the dominating sex. Cervical group of lymph nodes was the commonest presenting site. Mixed cellularity HD (MCHD) was the commonest subtype among Pakistani patients whereas Nodular Sclerotic HD (NSHD) was more common among Saudis. CONCLUSION: A comparison of the pattern of Pakistani and Saudi data of HD showed lack of bimodality in both. The male sex predominated. Morphologically the MCHD and NSHD were the commonest subtypes in Pakistani & Saudi patients respectively.

The spectrum of glomerulonephritis in saudi arabia: the results of the saudi registry.

Only few studies regarding glomerulonephritis, with relatively small numbers of patients, have so far been published from different centers in Saudi Arabia, and have reported conflicting results regarding the patterns, even in the same city. The possible reasons for these differences include the small number of patients in the different studies, differences in the indications for renal biopsies, referral bias, geographical differences, and, sometimes, the non-availability of the necessary diagnostic facilities in the reporting centers. In order to overcome these problems, a registry for glomerulonephropathy was attempted in Saudi Arabia. Six large referral hospitals from different regions of Saudi Arabia participated in this registry. Biopsy reports and clinical information of 1294 renal biopsies were obtained. There were 782 renal biopsies due to glomerulonephritis (GN) accounting for 77.2% of the total biopsies. Five hundred eighty seven (72.6%) were primary glomerulonephritidis. Focal and segmental glomerulosclerosis (FSGS) (21.3%) and membrano-proliferative glomerulonephritis (MPGN) (20.7%) were the most common types found in the primary glomerulonephritidis. Membranous glomerulonephritis (MGN) was present in only 10.6% of the cases. IgA nephropathy was found in 6.5% of the cases. Of the secondary glomerulo-nephritides, systemic lupus erythematosus (SLE) was the most common indication for biopsy (57.0%) and amyloidosis was found in only 3.2% of the biopsies. In conclusion, FSGS and MPGN were the most common forms of primary glomerulonephritis in adult patients in Saudi Arabia. MGN was not as common as in the western world. SLE was the commonest cause of secondary GN. Amyloidosis was not as common as in other Arab countries. There is a need for more centers from Saudi Arabia to join this national GN registry. Similar registries can be established in different Arab countries, which all would, hopefully, lead to a Pan-Arab GN registry.

Percutaneous renal biopsy and its findings in children and adolescents in saudi arabia: a single center experience.

A retrospective study of 108 consecutive renal biopsies in children and adolescents below 18 years of age performed at the King Fahd Hospital, Jeddah, during an eight-year period ending 1996, was made. All the biopsies were performed by a single consultant nephrologist and under ultrasound guidance. Tru-cut needles were employed in all cases and in the last two years, the bioptic gum was used. The age of the patients ranged between 3 months and 18 years with a mean of 10.6 years. There were 58 males and 50 females. All patients tolerated the biopsy well and there were no failures. The common side effects noted included gross hematuria in three (2.8%) and severe pain at the biopsy site in 11 (10.2%). None of the patients needed blood transfusions or prolonged hospitalization. Nephrotic syndrome was the commonest indication for performing the biopsy (83.3%) and among them, minimal change was the commonest lesion found (25%) followed by focal and segmental glomerulosclerosis (14.8%) and mesangial proliferative glomerulonephritis (15.7%). Our study further shows that renal biopsy is a safe procedure in children and the commonest indication is nephrotic syndrome.

Renal transplantation at the jeddah kidney center.

Renal transplantation is the optimal treatment for patients with end-stage renal failure. During the period 1991 to 1995, a total of 279 renal transplantations were performed at the Jeddah Kidney Center. They included 115 kidneys from cadaveric donors and 164 living related donor transplants. There were 160 males and 119 females; age of the patients ranged between 4 and 45 years. During the follow-up period, 32 grafts were lost and 26 patients died. The overall 5-year graft and patient survival rates were 79.2% and 90.7% respectively. Sepsis and pulmonary embolism constituted the common causes of death.

The Diagnosis of Acute Renal Allograft Rejection Using T-lymphocyte Subsets in the Peripheral Blood: A Better Test Now?

Measuring the T-lymphocyte subsets CD4/CD8 ratio is known to be useful in the early diagnosis of acute rejection. A ratio of 1.3 or more is said to indicate the presence of acute rejection, but the sensitivity and specificity rates of the test are too low to render it of diagnostic value. We revisited this test on twenty-three renal allograft recipients who developed graft dysfunction within the first three months following transplantation. All cases were investigated thoroughly to identify the cause of graft dysfunction. Two groups of patients were identified. Group 1: patients confirmed to have acute rejection as the cause of graft dysfunction (13 patients); and group 2: patients found to have other causes of graft dysfunction (10 patients). Results of subsets with cluster of differentiation ratio CD4/CD8 were correlated with incidence of acute rejection. Of the 13 patients with acute rejection 10 revealed a CD4/CD8 ratio more than 1.7, while in the other three CD4/CD8 ratio was less than 1.7. In the second group of 10 patients in whom the cause of graft dysfunction was not acute rejection, the CD4/CD8 ratio was less than 1.7 in all cases. Our study indicates that T-lymphocyte subset ratio is useful in diagnosing acute rejection with a sensitivity and specificity of 81% and 100% respectively when the cutoff point is taken as 1.7. Studies with larger series of patients are needed to confirm this observation.

Can Uremia and Hemodialysis Affect Plasma Levels of Circulating TNF-alpha.

It is well known that uremia is associated with increased susceptibility to infection. In addition, patients on haemodialysis (HD) experience a variety of dialysis associated complications, both acute and chronic, many of them having features similar to acute phase response. Immunoregulatory cytokines such as tumor necrosis factor-a (TNF-a) have been implicated in the pathogenesis of immunological as well as inflammatory diseases. Thus, TNF-a levels could be expected to be high in uremic patients as well as in HD patients. We investigated the plasma levels of TNF-a in 17 patients with renal failure, seven patients with chronic renal failure (CRF) before commencement of HD and 10 patients maintained on regular HD. Eight age matched healthy subjects were studied as normal control. All CRF patients, who were not yet on dialysis, had high plasma levels of TNF-a (mean + SD 71.33 + 33.25 pg/ml). Out of the HD group, TNF-a plasma levels were not detectable in five patients and in the remaining five, TNF-a plasma level (mean + SD 21.06 + 7.72) were comparable to the normal controls (mean + SD 21 + 7.87). Our findings suggest that factors related to uremia, but not to HD, are responsible for high TNF-a plasma levels in these patients and that, HD probably has a beneficial effect by removal and/or neutralising of uremic toxins.