Unusual cause of bilateral vocal cord paralysis.

The most common cause of vocal cord paralysis (VCP) as a result of recurrent laryngeal nerve compression is malignant tumors. A benign and inflammatory causes of VCP is rarely reported in the literature, and in almost all reported cases it was a unilateral paralysis. We report a rare case of tuberculous mediastinal lymphadenopathy causing bilateral VCP in a young female patient.

Congenital mesenterico-portal (Rex) shunt.

Congenital anomalies of the portal and umbilical-venous system are rare, with few reported cases. We describe a case where the native umbilical vein had acquired mesenteric venous outflow to bypass an in-utero portal-vein (PV) obstruction and restore normal venous return to the liver. This is analogous to the recently described Rex shunt procedure used in some cases of extrahepatic portal hypertension due to PV occlusion.

Congenital cystic disease of the lung in infants and children (experience with 57 cases).

A retrospective analysis of 57 consecutive cases with congenital cystic disease of the lung admitted to King Faisal Specialist Hospital and Research Center and King Khalid University Hospital, Riyadh, between 1985-1995 is presented. There were 37 congenital lobar emphysema (CLE), 7 cystic adenomatoid malformation (CAM), 8 bronchogenic cyst (BC) and 5 pulmonary sequestrations (PS). There were 39 males and 18 females with ages ranging from 1 day to 5 years. All patients were symptomatic except three. Respiratory distress, repeated chest infections, and cystic changes noted in chest x-ray were the commonest presentation. Five of eight patients with BC presented with symptoms related to pressure effect of the cyst on the surrounding structures, these included bronchiectasis in two patients, bronchopleural fistula in one, pulmonary artery stenosis and bronchomalacia in one, airway obstruction mimicking bronchial asthma in one. Seven patients (12.2%) were treated conservatively, the remaining underwent surgery. Surgery included excision of the bronchogenic cyst and lobectomy for CLE, CAM, and intralobar sequestration. The post-operative course in most cases was uneventful. There were no deaths in this series, and the majority of patients had a satisfactory outcome with follow-up ranging from 1-72 months (mean 24 months). It appears that lobectomy for symptomatic CLE, CAM, and intralobar sequestration and excision for bronchogenic cyst offer the best treatment modality and is well tolerated by pediatric patients. Careful search for associated anomalies is important to obtain better outcome.

Squamous cell carcinoma of the anal region at the King Faisal Specialist Hospital and Research Centre.

This study documents the epidemiological aspects of squamous cell carcinoma of the anus and anal canal as it has presented to the King Faisal Specialist Hospital and Research Centre (KFSH&RC). Thirty-eight (33 Saudis) patients, 24 males and 14 females were studied. They ranged in age from 32 to 100 years. Twenty-four had anal canal tumors and 12 had anal margin cancers. Riyadh, the Eastern Province or Medina provided most patients and the majority presented with bleeding, a lump or pain. Symptom duration ranged from one month to more than two years. Fourteen had previous anal problems. There was an almost equal distribution of lesions between the anterior and posterior halves of the anus. Nineteen had clinically normal inguinal nodes. Thirty had squamous cell carcinoma (epidermoid) and eight had cloacogenic/basiloid tumors. Most tumors were either moderately or poorly differentiated. Twenty-eight presented with T3 or T4 tumors and only ten presented with T1 or T2 tumors. Five had evidence of metastases at initial presentation. Eight were treated by abdominoperinal resection of the rectum. A diversion colostomy was performed in six. Fifteen received radiotherapy alone but only three were treated by chemotherapy alone. Combination chemotherapy and radiotherapy was given to 14. More males than females had both anal canal and anal margin tumors. Patients with anal margin tumors were on average ten years older. There were twice as many with anal canal as anal margin tumors. There were more node-positive patients with anal margin tumors. Anal canal tumors were less well-differentiated. Follow-up was inadequate.