Rhinoscleroma: a clinicopathological study from the Gulf region.

INTRODUCTION: Rhinoscleroma is a chronic progressive inflammatory disease of the upper respiratory tract. We report a clinicopathological series from the Gulf region. METHODS: The clinical and pathological features of patients diagnosed with rhinoscleroma at three main hospitals in Saudi Arabia and Bahrain over a 20-year period are presented. Archived glass slides and paraffin blocks from these patients were retrieved from the pathology files for review. Special stains were performed whenever indicated. Biopsy material and clinical data from 25 patients formed the basis of this study. RESULTS: Most of the patients were young females with a median age of 24 years. The nose was involved in all cases with frequent extension to other parts of the upper respiratory tract. The provisional clinical diagnoses included syphilis, midline granuloma and malignancy. The histological differential diagnoses included leprosy, malakoplakia and metastatic renal cell carcinoma. CONCLUSION: Rhinoscleroma is rare in Saudi Arabia and Bahrain. Awareness of possible clinical presentations and early diagnosis will significantly reduce the morbidity caused by this disease.

Comparison of RANTES expression in Crohn's disease and ulcerative colitis: an aid in the differential diagnosis?

BACKGROUND: RANTES (regulated on activation, normal T cell expressed and secreted) expression is increased in inflammatory bowel disease (IBD). RANTES is produced at higher levels in granulomatous conditions, so increased RANTES expression can be expected in Crohn's disease compared with ulcerative colitis. AIM: To compare RANTES expression between intestinal biopsy specimens of patients with Crohn's disease and those with ulcerative colitis. MATERIALS AND METHODS: A prospective study of patients presenting with lower gastrointestinal symptoms at the Bahrain Specialist Hospital from July 2004 to April 2005 was carried out. Endoscopic colonic biopsy specimens were taken from every patient and subjected to (a) routine haematoxylin and eosin staining examination by light microscopy, (b) immunohistochemistry for examination of RANTES protein expression by light microscopy and (c) in situ hybridisation for examination of RANTES mRNA expression by light microscopy. RANTES expression was assessed and quantified. RESULTS: 58 patients were enrolled to the study. Of them, 40 had IBD (21 had Crohn's disease and 19 had ulcerative colitis), 15 were controls with normal colonic biopsy results or non-inflammatory lesions and 3 had colonic inflammatory lesions other than IBD. RANTES expression in lymphocytes or histiocytes was significantly higher (p = 0.04) in new patients with ulcerative colitis than in those with Crohn's disease analysed by immunohistochemistry (IHC). CONCLUSION: RANTES expression in lymphocytes or histiocytes is significantly higher in patients with ulcerative colitis than in those with Crohn's disease. Hence, RANTES IHC can be an effective method for distinguishing between biopsy specimens of patients with ulcerative colitis from those of patients with Crohn's disease, where routine histological features are indeterminate. RANTES IHC may prove to be a useful technique for identifying early or equivocal granulomas.

Clinical and histopathological features of zoonotic cutaneous leishmaniasis in Saudi Arabia.

BACKGROUND: Zoonotic cutaneous leishmaniasis (ZCL) caused by Leishmania major is a growing public health problem and endemic in many parts of the Kingdom of Saudi Arabia. The vector is Phlebotomus papatasi and the animal reservoirs are mainly desert rodents. METHODS: In this prospective study, the clinical and histopathological features of ZCL in 120 patients are described and classified. The majority of these patients (n = 84) were non-Saudi expatriate workers who suffered mostly from multiple and severely inflamed nodulo-ulcerative lesions on the exposed parts of the body. Saudi patients were mainly children (n = 21) with few(1-3) lesions on their limbs or sometimes unique erysipeloid facial lesions. RESULTS: Histopathological grouping of ZCL lesions showed four types of granulomatous reactions based on the predominant types of inflammatory cells, presence or absence of necrosis and ranking of parasitic index. CONCLUSION: A possible correlation between histopathologic evolution of ZCL lesions and the immune status of the host is discussed.

Is visualising ureter before pyeloplasty necessary in adult patients?

In this study, we aimed to detect whether or not visualising ureter and ureteropelvic junction (UPJ) preoperatively is necessary in adult patients who have primer UPJ obstruction. Between January 1995 to June 1999, 46 renal units in 45 patients with primer UPJ obstruction were evaluated. The patients were separated into 2 groups. In group 1, intravenous pyelography (IVP) and renal scintigraphy were performed to 17 renal units preoperatively. In group 2, in addition to these methods, either retrograde pyelography (RGP) or antegrade pyelography (AGP) were performed to 29 renal units. Renal/bladder sonogram was used in patients with poor renal function in IVP or in renal scintigraphy. All the operations were performed through a flank incision. In group 2, additional information was gained for 8 (27.5%) of the renal units preoperatively. No additional information for this group found intraoperatively. In group 1, we found additional information in 4 (23.53%) of the units intraoperatively. All the pathologies in both groups were corrected intraoperatively. Double-J (D-J) stent was used in 6 (35.29%) of the units in group 1 and 8 (27.58%) of the units in group 2 intraoperatively (p > 0.05). In group 2, 4 (13.79%) preoperative complications were seen due to RGP and they were treated either medically or conservatively. In the early postoperative period, a complication observed in 1 (5.88%) of the patients in group 1 and 1 of the patients in group 2 (3.44%) (p > 0.05). The first patient was treated with inserting D-J and the latter one was treated conservatively. In the 3rd postoperative month, success rate was found to be 94.11% in group 1 and 96.55% in group 2 (p > 0.05). Additional pathologies in adult patients with primer UPJ obstruction can be corrected intraoperatively through a flank incision. Therefore, imaging of ureter and UPJ may not be necessary in these patients.

Simultaneous medullary carcinoma, occult papillary carcinoma and lymphocytic thyroiditis.

A 55-year-old female underwent total thyroidectomy for medullary carcinoma of the left lobe of the thyroid. The right lobe showed an incidental occult papillary carcinoma. There was also diffuse lymphocytic thyroiditis. Immunohistochemistry for calcitonin and thyroglobin confirmed the separate histogenesis for both carcinomas. The coexistence of medullarry and papillary carcinoma of the thyroid is rare and the literature usually documents mixed tumours with features of both carcinomas, rather than independent tumours, as in our case.

Racial variation in the O-acetylation phenotype of human colonic mucosa.

O-acetylated and non-O-acetylated sialoglycoproteins can be distinguished by the mPAS (mild periodic acid-Schiff) histochemical technique. Individual adults show one of three different patterns of staining of large intestinal mucosa: uniformly mPAS-positive, uniformly mPAS-negative, or mPAS-negative with scattered mPAS-positive crypts. To test our hypothesis that these variations are the result of a single autosomal gene (oat) polymorphism, we have studied the frequency of the three patterns of staining in a total of 435 adult colon specimens from six geographically separate populations: British, South African blacks, Icelanders, Japanese, Hong Kong Chinese, and Bahrainis. The distribution of the three types of staining fell into two groups. In Japanese and Chinese, uniformly mPAS-positive cases were much more frequent than uniformly mPAS-negative cases; this distribution differed significantly (chi 2, P < 0.001) from that in non-Sino-Japanese, where the uniformly mPAS-positive phenotype was much less frequently found than the uniformly mPAS-negative phenotype. In neither of the groups did the frequency of the three phenotypes differ significantly from that predicted for a single gene polymorphism by the Hardy-Weinberg law. The variation in staining patterns between populations is consistent with variation in frequency of a single polymorphic autosomal gene (oat) controlling O-acetylation of sialic acid, probably by an O-acetyl transferase enzyme. Loss of function mutation in the high acetylator gene (oata) in a colonic crypt stem cell in heterozygous individuals would account for the scattered discordant crypts. Gene frequencies for a variety of enzymes differ between the Sino-Japanese and non-Sino-Japanese races.(ABSTRACT TRUNCATED AT 250 WORDS)

Phycomycosis of the abomasum in Camelus dromedarius.

Two cases of phycomycosis of the abomasum in dromedary camels are described. In one of the cases there is evidence of spread to the liver. The pathology and pathogenesis of the disease are discussed. We believe this is the first report of phycomycosis in Camelidae.

Combination chemotherapy only for stage II non-Hodgkin's lymphoma.

Twenty-six previously untreated patients with clinical stage (CS) II B non-Hodgkin's lymphoma (NHL) were treated with systemic chemotherapy only. Patients received bleomycin, adriamycin, cyclophosphamide, vincristine and prednisone (BACOP). All patients had intermediate- or high-grade lymphoma. Objective response was demonstrated in 25 patients (96%), with 21 patients (81%) achieving complete remission (CR). Two of CR patients developed unsalvageable relapse, the remaining 19 patients are still alive and disease-free. The median duration of CR has not been reached. Of four patients (15%) with documented partial remission (PR), three were salvaged using second-line therapy. Over a median follow-up of 12 months (range, 3-30), 22 patients (85%) are alive and disease-free, of whom 16 (62%) have survived more than 1 yr. Bulky disease or gastrointestinal tract (GIT) involvement did not influence the CR rate. Our results compared favorably with radiation therapy for stage II NHL; however, a larger controlled and randomized study is warranted.

Primary hepatocellular carcinoma in the eastern province of Saudi Arabia: treatment with combination chemotherapy using 5-fluorouracil, Adriamycin and mitomycin-C.

An analysis is done of 40 evaluable patients treated with a combination of 5-Fluorouracil, adriamycin and mitomycin-C for primary hepatocellular carcinoma in Saudi Arabia. In only 5 patients (12.5%) objective partial remission was achieved. The duration of remission for responding patients was: 6, 6, 8, 12 and 20 weeks, respectively. Responders demonstrated a short survival time of 8, 8, 10, 15 and 33 weeks. The median survival time of non-responders was 8 weeks, which was not different from that of responders. An analysis of potential factors that might contribute to our poor results is presented.

Spinal cord compression due to intrathoracic extramedullary haematopoiesis in homozygous thalassaemia.

A rare condition of massive intrathoracic extramedullary haematopoiesis causing spinal cord compression is presented in a 17-year-old Saudi male. Both clinical and laboratory findings, together with the computed tomographic evaluation of the lesion are described. Partial surgical resection as an alternative to radiotherapy has resulted in a dramatic response.

The significance of mammary skin edema in noninflammatory breast cancer.

Mammary skin edema has been quantitated in 205 cases of T1, T2 and T3 breast cancer by mammographic measurement, and its prognostic significance assessed. Edema was present in 70% of patients and the incidence was directly related to tumor size. Edema was seen on occasions in all quadrants of the breast, but the inner and lower quadrants were the most frequent sites of edema irrespective of the site of tumor. Histology showed the skin thickening located in the reticular dermis; the papillary dermis and epidermis showed no change. It was shown that neither dermal lymphatic involvement nor lymphatic obstruction by regional node involvement was of primary etiological significance. Skin edema correlates with prognosis since there is an increased likelihood of both systemic and local recurrence if skin edema exceeds 0.5 mm. Further investigation and longer follow-up is necessary to show whether skin edema represents a parameter which carries prognostic significance independent of the more usual clinical indications.

Highlights on the etiology of keloid.

The keloid phenomenon is old and perplexing. Many hypotheses were advanced to account for keloid growth but none of them provided a satisfactory explanation for the clinical manifestations of the disease. To solve the mystery of keloid detailed clinical studies coupled with laboratory tests were undertaken on keloid and non-keloid individuals; these highlighted the determinants of the disease and paved the way to the formulation of the Sebum Auto-immune Theory. The latter provided valid explanations for the clinical manifestations of the disease and indicated a rationale for new trends of management.

Observations on hepato-cellular carcinoma in the Sudan.

The clinical and histopathological features of hepato-cellular carcinoma in 24 Sudanese patients seen in Khartoum Civil Hospital in a 4 year period are described. The tumour represented 1.97 per cent of total medical admissions and constituted 40 per cent of all malignancies seen. The age range was 30 to 88 with a mean age of 54 years. The male:female ratio was 6:1. A regional variation was apparent and is possible that the disease is more common in the Western Sudan than in other parts of the country.

Morphology of the spleen and lymph nodes in fatal visceral leishmaniasis.

Histological appearances of the spleen and lymph nodes were analysed in twenty fatal cases of human visceral leishmaniasis from Sudan. Marked atrophy of the splenic white pulp was associated with necrosis and fibrosis of thymus-dependent area, accumulation of parasite-containing histiocytes and plasma cell hyperplasia. Depletion of small lymphocytes in the paracortical areas of the lymph nodes was accomplained by proliferation of plasma cells and histiocytes in the paracortex. Depletion of small lymphocytes in thymus-dependent regions of lymph nodes and spleen is viewed as arising from immune suppression associated with antigen overloading or other factors, which may impair those aspects of lymphocyte-macrophage cooperation that are presumably necessary to kill the invading parasites.

The pathology of schistosomiasis in Sudan.

The pathology of schistosomiasis in an autopsy material consisting of medico-legal cases and unclaimed bodies in the Sudan is described. The limitations of this type of study are pointed out. S. mansoni-infection and S. haematobium-infection occurred with a frequency of 14.3 per cent and 4.5 per cent of autopsies respectively. There was a geographical difference in the severity of S. mansoni-infection in two endemic areas in the country; it was particularly severe in patients coming from Bor area in the Southern Sudan. In autopsies with S. mansomi-infection intestinal polyposis and cor pulmonale were rarely encountered. The distribution of eggs in the tissues, using digestion studies, and the relationship of tissue egg load to pathology are reported and discussed.

Salmonellosis complicating schistosomiasis in the Sudan.

Salmonella typhi or Paratyphi A was isolated from the blood in 16 out of 21 Suanese patients who had prolonged fever of one of 10 months' duration and hepatesplenic schistosomiasis. Most patients had severe anaemia. The serum alkaline phosphatase was raised in 16 patients. Bilharzial lesions were demonstrated in the liver biopsies of 10 patients. Three patients had in addition the nephrotic syndrome and moderate proteinuria was present in nine other patients. Changes of proliferative glomerulonephritis were noted in the renal biopsies of two patients with the nephrotic syndrome. Treatment with chloramphenicol cured the salmonella infection in all patients, reversed the raised alkaline phosphatase and the proteinuria, and led to a marked reduction in the size of the hepatosplenomegaly.