Gastrointestinal stromal tumours (GISTs): case report and review of the literature.

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract, the majority of which is KIT (CD117) positive. In this case report, we describe a case of recurrent and metastatic GIST who presented with hepatic and brain metastases. Despite the patient's GISTs was negative for c-Kit (CD 117), he responded to imatinib mesylate (Glivec) treatment with complete resolution of his liver and brain lesions. The patient has been and still in complete remission for 18 months of follow-up.

Magnetic resonance imaging of tuberculous spondylitis.

STUDY DESIGN: This retrospective study analyzed the magnetic resonance imaging characteristics of tuberculous spondylitis. OBJECTIVE: To describe the magnetic resonance imaging characteristics of tuberculous spondylitis and compare the diagnostic yield of magnetic resonance imaging versus other modalities. SUMMARY OF BACKGROUND DATA: Tuberculous spondylitis is not an uncommon occurrence with extrapulmonary disease. It requires prompt diagnosis and management. In the pre-magnetic resonance imaging era, computed tomography was used to delineate the associated radiologic changes. Data are limited that describe the magnetic resonance imaging pattern of tuberculous spondylitis and the effect of post-contrast enhancement. METHODS: The magnetic resonance imaging characteristics of 28 vertebrae in 12 patients with tuberculous spondylitis were studied. RESULTS: The thoracic spine was the most commonly involved region, with involvement occurring in the thoracic spine alone in 12 vertebrae (43%) and with other areas of the spine in an additional five (18%). Partial involvement was detected in the majority of the vertebral lesions (24; 86%). Magnetic resonance imaging evidence of disc space involvement was apparent in only 46% of the lesions. Paraspinal abscess and epidural extension were documented by magnetic resonance imaging in 71% and 61% of lesions, respectively. Decreased signal intensity on T1-weighted images was demonstrated in 13 vertebrae (46%), with increased signal intensity on T2-weighted images seen only in five (18%). CONCLUSION: Magnetic resonance imaging is a useful diagnostic modality for patients with suspected tuberculous spondylitis. Partial vertebral involvement and paraspinal and epidural extension were delineated. Study of the signal intensity on T1- and T2-weighted images revealed a pattern that may be dissimilar to that commonly reported. Post-contrast enhancement adds more certainty to the diagnosis of tuberculous spondylitis.

Postmenopausal osteoporosis in Saudi women: A pilot screening.

One hundred and ten radiographs of calcaneum were reviewed for postmenopausal osteoporosis in Saudi women. These patients had presented to the emergency room with unrelated complaints. The mean (+/- SD) age of this group was 58 (+/-8.9) years with a range of 45 to 80 years. Of these eighty-six (76%) patients had osteoporosis; of these, 42 had mild osteoporosis, 31 had frank osteoporosis, and 11 were diagnosed to have sever osteoporosis. Women with severe osteoporosis were significantly older than those with mild (P=0.0417) as those who were normal (P=0.002). This study indicates a high prevalence of postmenopausal osteoporosis in Saudi women and multicenter, large scale screening should be instituted to determine the incidence of postmenopausal osteoporosis among Saudi women.

Fatty infiltration of the liver: analysis of prevalence, radiological and clinical features and influence on patient management.

Over a 6-year period, in 1425 adult computed tomographic studies, radiological evidence of fatty infiltration of the liver (FIL) was found in 138 patients (9.7%). Patients with FIL had a mean age +/- SD of 45.9 +/- 15.7 years and 57% were males; the majority were Saudis (73%). Most patients (95%) had one or more underlying aetiological causes. Haematological and non-haematological malignancies with or without liver involvement were the most frequently encountered aetiological factors (66% of patients). FIL contributed to hepatomegaly or was associated with abnormality in one or more of the liver function tests in 30% and 39% of patients, respectively. Assessment of the various radiological patterns showed diffuse fatty changes in 68% of patients and solitary or multiple focal changes in 9% and 22%, respectively. 13 patients (9%) showed sparing of the caudate lobe within a diffuse fatty process. Patients with diffuse FIL had significantly higher values for alkaline phosphatase (p = 0.0016) and serum asparate aminotransferase (p = 0.0251) than those who had the focal pattern. FIL in 20 patients (14%) imposed a difficulty in making an appropriate diagnosis, led to inaccurate impressions, or forced unnecessary invasive or non-invasive investigations. We conclude from our large series of patients that FIL is not uncommon in hospital practice and among those at risk should always be considered as an appropriate diagnosis.

Choanal atresia: How useful is computed tomography.

Computed tomography (CT) has recently been hailed as the most useful tool in the diagnosis and management of congenital posterior choanal atreasia. Our study of 11 patients with posterior choanal atresia by CT does not seem to confirm this claim. CT, which demonstrates very clearly all the anatomical details of the region, does not appear to play any major role in the diagnosis of the condition; nor in the planning of the management of patients in whom posterior choanal atreasia is the only major craniofacial abnormality.

Tuberculosis in patients with malignant disease.

Of 2,143 biopsy proven cancer patients seen at our hospital over a six year period, 4 (0.19%) patients developed active tuberculosis (TB) during anticancer therapy or shortly after its completion. The cancer diagnoses of those patients were non-Hodgkin's lymphoma, breast cancer, chronic myelogenous leukemia, and astrocytoma. Institution of antituberculous therapy was successful in three patients, however, the TB course was rapidly fatal in the fourth patient with non-Hodgkin's lymphoma despite therapy. The association between TB and neoplasia is emphasized. TB complicating malignant disorders represents complex problem regarding its early recognition and its managements.

Angiomyolipoma of the nasal cavity.

Vascular tumours of the nasal cavity are uncommon and are either hamartomas or true neoplasms, mostly benign. We present an unusual case of angiomyolipoma of the nasal cavity. This hamartomatous lesion is often described in the kidney and may be associated with tuberous sclerosis. To our knowledge, there is no previous report of the lesion in the nasal cavity, and no association with tuberous sclerosis has been demonstrated in this case.

Primary paranasal Aspergillus granuloma in Saudi Arabia.

Respiratory aspergillosis has been described in many parts of the world; but primary paranasal aspergillus granuloma (PPAG), a recognised, distinct entity, has been described almost exclusively in Africa--specifically in the Sudan. The first case of PPAG in Saudi Arabia with bilateral involvement of paranasal sinuses is described. In view of the geographical similarities between Northern Sudan and Saudi Arabia, it is suggested that some of the granulomatous inflammatory conditions occurring in Saudi Arabia for which no definite aetiological agent has been ascribed may fall into this category. Increased awareness of the condition, together with the use of serological methods currently in use in the Sudan may help in defining the condition properly in this locality.

Traditional remedies and lead intoxication.

Three Saudi children suffered from lead intoxication as a result of ingestion of a preparation prescribed by a traditional practitioner. Two of them showed no symptoms of lead intoxication while the third child gave a history of symptomatic intoxication in the form of convulsions. The blood lead levels were increased in all patients and radiographic lead bands were seen in the long bones of the three children. The blood lead concentration was decreased by Na-Ca-EDTA and BAL treatment in the three patients.