Fine structure of the dorsal lingual epithelium in Tarentola annularis and Crocodylus niloticus.

The present study examined the morphological features, histological and histochemical aspect of the tongue of two reptilian species, Tarentola annularis (family: Gekkonidae) and Crocodylus niloticus (family: Crocodylidea), with different habitats, feeding patterns and behaviours, by light and scanning electron microscope. It was observed, that the bifurcation of the tongue was more visible in Tarentola annularis. Conical and filamentous papillae were observed on the lingual body of Tarentola annularis, while in Crocodylus niloticus both mechanical filiform and gustatory papillae appeared. The lingual mucosa in Tarentola annularis is covered by stratified squamous epithelium and keratinised but in Crocodylus niloticus it is highly folded and more heavily keratinised in the folded region and have a localised thickenings structure resembling taste buds. Mucous glands appeared in Tarentola annularis and compound tubular glands in Crocodylus niloticus. At scanning electron microscopy, abundant microridges and microvilli in both species were exhibited on papillae surface facilitated feeding habits. Histochemically, the tongue of two species is strongly positive for carbohydrate stain but with variable degree with others stains. In conclusion, there is a marked correlation between the structure of the tongue of the present reptilian species, habitats and feeding mechanism of the two species.

Effects of experimentally induced maternal hypothyroidism and hyperthyroidism on the development of rat offspring: II-the developmental pattern of neurons in relation to oxidative stress and antioxidant defense system.

Excessive concentrations of free radicals in the developing brain may lead to neurons maldevelopment and neurons damage and death. Thyroid hormones (THs) states play an important role in affecting the modulation of oxidative stress and antioxidant defense system. Thus, the objective of this study was to clarify the effect of hypothyroidism and hyperthyroidism in rat dams on the neurons development of different brain regions of their offspring at several postnatal weeks in relation to changes in the oxidative stress and antioxidant defense system. The adult female rats were administered methimazole (MMI) in drinking water (0.02% w/v) from gestation day 1 to lactation day 21 to induce hypothyroidism and exogenous thyroxine (T4) in drinking water (0.002% w/v) beside intragastric incubation of 50--200 T4 µg/kg body weight (b. wt.) to induce hyperthyroidism. In normal female rats, the sera total thyroxine (TT4) and total triiodothyronine (TT3) levels were detectably increased at day 10 post-partum than those at day 10 of pregnancy. Free thyroxine (FT4), free triiodothyronine (FT3), thyrotropin (TSH) and growth hormone (GH) concentrations in normal offspring were elevated at first, second and third postnatal weeks in an age-dependent manner. In hypothyroid group, a marked depression was observed in sera of dam TT3 and TT4 as well as offspring FT3, FT4 and GH, while there was a significant increase in TSH level with the age progress. The reverse pattern to latter state was recorded in hyperthyroid group. Concomitantly, in control offspring, the rate of neuron development in both cerebellar and cerebral cortex was increased in its density and complexity with age progress. This development may depend, largely, on THs state. Both maternal hypothyroidism and hyperthyroidism caused severe growth retardation in neurons of these regions of their offspring from the first to third weeks. Additionally, in normal offspring, seven antioxidant enzymes, four non-enzymatic antioxidants and one oxidative stress marker (lipid peroxidation, LPO) followed a synchronized course of alterations in cerebrum, cerebellum and medulla oblongata. In both thyroid states, the oxidative damage has been demonstrated by the increased LPO and inhibition of enzymatic and non-enzymatic antioxidants in most examined ages and brain regions. These disturbances in the antioxidant defense system led to deterioration in the neuronal maturation and development. In conclusion, it can be suggested that the maldevelopment of neurons and dendrites in different brain regions of offspring of hypothyroid and hyperthyroid mother rat dams may be attributed, at least in part, to the excess oxidative stress and deteriorated antioxidant defense system in such conditions.

Comparative study of the effects of experimentally induced hypothyroidism and hyperthyroidism in some brain regions in albino rats.

Thyroid hormones (THs) play a crucial role in the development and physiological functioning of different body organs especially the brain. Therefore, the objective of this study was to show the histopathological effects of the different thyroid states on some brain regions (cerebrum and cerebellum) and the skeletal features of their newborns during the postnatal development from the 1st to 3rd week. The female white albino rats were allocated into 3 groups as follows: the experimental hypothyroidism group is induced by 0.02% methimazole (MMI) (w/v) in drinking water, while the experimental hyperthyroidism group is performed by exogenous T4 [from 50 to 200microg/kg body weight intragastric administration beside adding 0.002% T4 (w/v) to the drinking water] from the gestation day 1 to lactation day 21 and control group which received tap water. As well, both maternal hypo- and hyperthyroidism caused some malformation and developmental defects in the cerebellar and cerebral cortex of their newborns along the duration of the experiment. These degenerative symptoms became more prominent and widely spread at the 3rd postnatal week. Concomitantly, there were some degeneration, deformation and severe growth retardation in neurons of these regions in both treated groups throughout the experimental period. Moreover, the skeletal features of these newborns were accelerated in hyperthyroid group while these maturations were delayed partially in hypothyroid ones during the examined periods. These alterations, on both treated groups, were age and dose dependent. Thus, further studies need to be done to emphasize this concept.

Thyroid hormones states and brain development interactions.

The action of thyroid hormones (THs) in the brain is strictly regulated, since these hormones play a crucial role in the development and physiological functioning of the central nervous system (CNS). Disorders of the thyroid gland are among the most common endocrine maladies. Therefore, the objective of this study was to identify in broad terms the interactions between thyroid hormone states or actions and brain development. THs regulate the neuronal cytoarchitecture, neuronal growth and synaptogenesis, and their receptors are widely distributed in the CNS. Any deficiency or increase of them (hypo- or hyperthyroidism) during these periods may result in an irreversible impairment, morphological and cytoarchitecture abnormalities, disorganization, maldevelopment and physical retardation. This includes abnormal neuronal proliferation, migration, decreased dendritic densities and dendritic arborizations. This drastic effect may be responsible for the loss of neurons vital functions and may lead, in turn, to the biochemical dysfunctions. This could explain the physiological and behavioral changes observed in the animals or human during thyroid dysfunction. It can be hypothesized that the sensitive to the thyroid hormones is not only remarked in the neonatal period but also prior to birth, and THs change during the development may lead to the brain damage if not corrected shortly after the birth. Thus, the hypothesis that neurodevelopmental abnormalities might be related to the thyroid hormones is plausible. Taken together, the alterations of neurotransmitters and disturbance in the GABA, adenosine and pro/antioxidant systems in CNS due to the thyroid dysfunction may retard the neurogenesis and CNS growth and the reverse is true. In general, THs disorder during early life may lead to distortions rather than synchronized shifts in the relative development of several central transmitter systems that leads to a multitude of irreversible morphological and biochemical abnormalities (pathophysiology). Thus, further studies need to be done to emphasize this concept.

Atypical forms of spinal tuberculosis: case report and review of the literature.

OBJECTIVE: The object of this report is to highlight some of the less known atypical features of spinal tuberculosis (TB) in the hope of facilitating early diagnosis. Pure neural arch and sacral TB is rare and the co-existence of these two as widely separated skip lesions in the same patient is even rarer. CLINICAL PRESENTATION: An unusual case of tuberculous process affecting the sacrum as well as the neural arches of upper cervical vertebrae is presented. Neither the clinical features nor the imaging techniques, including radiography, bone scintigraphy, computed tomography, and magnetic resonance imaging, were helpful in establishing the diagnosis. The destructive lesion of the sacrum with a rectally palpable presacral mass was thought to be a chordoma or chondrosarcoma until the patient developed upper cervical cord compression with an extradural myelographic block. Development of this second destructive lesion involving the posterior spinal elements (the neural arch) led to a diagnosis of malignant spinal metastasis. The true diagnosis was only revealed by the histology of the solid tumor-like extradural mass in the upper cervical region and demonstration of acid-fast bacilli (AFB) in the lesion. Anti-TB chemotherapy resulted in complete resolution of sacral and cervical lesions as well as the neurologic deficits. CONCLUSION: Differential diagnosis of the obscure spinal lesion should include tuberculosis, specifically the atypical forms; especially because complete cure is possible with early treatment and neurologic morbidity is high in neglected cases.

Laparoscopic cholecystectomy for cholelithiasis during infancy and childhood: cost analysis and review of current indications.

Eleven consecutive laparoscopic cholecystectomies (LCs) were performed between January 1994 and June 1996 compared with seven open cholecystectomies (OCs) performed previously at King Khalid University Hospital. The comparison included surgical, clinical, and economic factors, together with a review of the literature. In the laparoscopic group the main indication for cholecystectomy was symptomatic gallstones. Other indications include mucocele of the gallbladder and chronic cholecystitis. A total of eight children in both group had sickle cell disease. The first two LCs were performed in the presence of an experienced laparoscopic surgeon. There is a learning curve to pass through with LC. The operating time for LC ranged between 65 and 135 minutes (mean +/- SD 89.81 +/- 21.89 minutes). There was no major morbidity or mortality. The average postoperative parenteral analgesia required for LC (50.45 +/- 24.57 mg) was significantly less than for OC (135.14 +/- 62.02 mg), and the mean length of hospitalization for LC was significantly shorter than that for OC (1.68 +/- 0.46 vs. 6.07 +/- 0.30) days. Although the average operative cost per LC (2522 SR) was significantly more expensive than for OC (350 SR), the ultimate cost of LC was significantly less than for OC (5790.00 +/- 787 vs. 12,343 +/- 139 SR) because the total period of hospitalization was much shorter. In conclusion, LC is safe, effective, and less expensive than OC and therefore is the approach of choice for cholecystectomy in children.

Laparoscopic cholecystectomy: The treatment of choice for cholelithiasis in infancy and childhood.

Twelve consecutive laparoscopic cholecystectomies (LC) were performed between January 1994 and October 1996 at King Khalid University Hospital. In all patients the indication for cholecystectomy was symptomatic gallstones. Among the 12 children, six had sickle cell disease. The operating time ranged between 65 and 135 minutes (mean=897plusmn;21.06). There was no major morbidity or mortality. The average duration of postoperative parenteral analgesia (pethidine hydrochloride) required was 0.47+/-0.19 day (ranged between 0.3 and one day). The average postoperative stay was 1.67+/-0.44 days (ranged between 1 and 2.5 days). In conclusion, LC is safe, effective and the preferred approach for cholelithiasis in children, with the advantages of short postoperative analgesia requirement, shorter hospitalization, and therefore, an early return to normal daily activities.

Trauma cases admitted to the surgical intensive care unit--progress and outcome.

A review of the trauma admissions to the Surgical Intensive Care Unit (SICU) at King Khalid University Hospital, Riyadh during the period from 30 October 1984 to 29 October 1989 was made. A total of 181 cases constituting 15.7% of the total surgical admissions to the unit during that period were recognised. The main cause of the trauma was road traffic accidents (83.4%). The male to female ratio in this group was 6.3:1. Thirty patients died in the SICU, 16 died within 24 hours of admission to the unit and the remaining 14 developed multiple organ failure prior to death. Positive cultures from different sites were obtained from 50% of them. Recommendations are made to improve the management of similar cases.

Surgery for postintubation tracheal and tracheosubglottic stenotic lesions.

Postintubation tracheal stenosis is a recognized problem. Although its incidence has recently decreases, it is still a difficult complication to treat. We have reviewed our experience with 10 patients with tracheal stenosis over the last five years between 1990 and 1995. There were seven male and three female patients with an average age of 14.2 +/- 4 years (range 6 to 48 years). Resection and reconstruction with primary anastomosis was performed in seven patients, while conservative treatment with dilatation was performed in two patients. One patient refused surgery. Operations performed included resection of tracheocricoid segment with tracheothyroid anastomosis (N=3) and tracheal resection with end-to-end anastomosis (N=4). The resected airway segment ranged from 3 cm to 6 cm. In view of the intense inflammatory and fibrotic process in and around the stenotic segment, the practice of tracheostomy for the relief of postintubation acute tracheal obstruction should not be taken lightly, as it adds not only to the severity of the inflammatory process, but also increases the length of the tracheal segment to be resected. Postoperatively, all patients were extubated; this was accomplished by the end of surgery in six patients, while the seventh patient was extubated three weeks later. There was no mortality in this series. When normal functional activity and airway patency were taken as two parameters to judge the outcome of surgery, results were good in six (86%) patients and satisfactory in one. These results support the validity of one-stage reconstruction approach as one alternative for the treatment of postintubation tracheal and tracheosubglottic stenotic lesions.

Heat exhaustion during mass pilgrimage--is there a diagnostic role for pulse oximetry?

Every year over 2 million pilgrims (Hajjis) gather from different countries to perform the sacred ritual, the fifth pillar of Islam, Hajj. Several nationalities from different climates come to Saudi Arabia which is located in a subtropical area with a hot and humid climate during the long summer season. This undertaking is characterised by several days of continuous physical, spiritual, and emotional exertion following their homeland. Several factors predispose them to heat exhaustion, such as the hot climate, excessive physical exercise, lack of acclimatisation, overcrowding, illiteracy, old age, diseases, and over zealous performance of Hajj during the peak sunshine hours. Several thousands of pilgrims suffer from heat exhaustion which is a minor form of heat illness that can easily be detected and treated. Patients are usually discharged having fully recovered, but if heat exhaustion is not treated immediately, it may result in heat stroke with serious sequelae. Cases that need further observation and management are admitted to hospital, particularly those who have associated medical disorders. This study was designed to investigate the role of pulse oximetry in detecting hypoxaemia in patients suffering from heat exhaustion. One hundred fifty-five patients from 26 different countries were enrolled in this study. Their ages ranged from 18 to 83 years. There were 51 (33%), 48 (31%), and 56 (36%) from Asia, the Middle East and Africa, respectively. One hundred thirty-four patients (86.5%) showed a form of hypoxia which necessitated O2 administration. Mild hypoxia (91-94% O2 saturation) was detected in 81 patients (52.3%) and moderate to severe hypoxia (< 90% O2 saturation) was detected in 53 (34.2%) patients.

Prophylactic antiemetic therapy with ondansetron, tropisetron, granisetron and metoclopramide in patients undergoing laparoscopic cholecystectomy: a randomized, double-blind comparison with placebo.

PURPOSE: Postoperative nausea and vomiting (PONV) is a distressing adverse effect of general anaesthesia. The aim of the current study was to compare the antiemetic activity of different 5-hydroxytryptamine3 receptor antagonists with that of metoclopramide and placebo. METHODS: In a prospective, randomized, double-blind study we have compared the antiemetic activity of the prophylactic administration of ondansetron 4 mg, tropisetron 5 mg and granisetron 3 mg with that of metoclopramide 10 mg and placebo in 132 patients undergoing laparoscopic cholecystectomy. All study drugs and placebo were given as a short iv infusion ten minutes before the induction of anaesthesia. Perioperative anaesthetic care was standardized in all patients. Nausea and vomiting were assessed by direct questioning of the patient at 1, 4, 9, 12, 18 and 24 hr after recovery from anaesthesia. If patients experienced nausea and/or vomiting, rescue antiemetic treatment (metoclopramide 10 mg iv) was administered. RESULTS: For the 24-hr recovery period after surgery, the percentages of emesis-free patients were 65.5%, 52%, 48%, 29.2% and 27.6% in the ondansetron, granisetron, tropisetron, metoclopramide and placebo groups, respectively. Prophylactic antiemetic treatment with ondansetron resulted in a lower incidence (P = 0.02) of PONV than with metoclopramide or placebo. The times at which rescue antiemetic was first received were longer (P < 0.01) in ondansetron group than in the placebo and metoclopramide groups. There were no statistical differences between ondansetron, tropisetron and granisetron groups. CONCLUSIONS: Ondansetron, when given prophylactically resulted in a significantly lower incidence of PONV than metoclopramide and placebo. Metoclopramide was ineffective.

Histamine-release haemodynamic changes produced by rocuronium, vecuronium, mivacurium, atracurium and tubocurarine.

We have examined the effects of different benzyl-isoquinolinium and steroidal neuromuscular blocking compounds on plasma concentrations of histamine, heart rate and arterial pressure in surgical patients. A single, rapid (5-s) bolus of mivacurium 0.2 mg kg-1, atracurium 0.6 mg kg-1, tubocurarine 0.5 mg kg-1, vecuronium 0.1 mg kg-1 or rocuronium 0.6 mg kg-1 was administered to 75 patients (n = 15 in each group). Anaesthesia was induced with thiopentone 6 mg kg-1 i.v. and maintained with isoflurane and 70% nitrous oxide in oxygen. Venous blood samples were obtained before induction, 1 min after thiopentone and 1, 3 and 5 min after administration of the neuromuscular blocking drug. Mivacurium, atracurium and tubocurarine caused 370%, 234% and 252% increases in plasma histamine concentrations at 1 min, respectively. Corresponding values at 3 min were 223%, 148% and 157%, respectively. These changes were significant (P < 0.01) at 1 and 3 min. In contrast, the rocuronium and vecuronium groups had no significant changes in either plasma histamine concentrations or haemodynamic variables.

Pattern and surgery for oesophageal carcinoma in Saudi Arabia.

Forty-three patients with carcinoma of the oesophagus are presented, 30 of whom were male and 13 female, with ages ranging from 42 to 88 years. Mean duration of symptoms was 4.6 months. Of patients, 65.2% were in stage III and 30.2% in stage IIA. Stages I and IV were encountered in one patient each. Twenty-five were Saudis and 14 non-Saudis. Of the Saudi patients, 64.3% were from the Qaseem region. 48.8% had subtotal oesophagectomy with neck anastomosis and 51.2% had limited oesophagectomy with intrathoracic anastomosis. The mortality rate was 11.6% The 5-year survival rate was 33.3%. We found sex, histology, stage of disease and extent of oesophageal resection influence long-term survival.

Comparative potency of steroidal neuromuscular blocking drugs and isobolographic analysis of the interaction between rocuronium and other aminosteroids.

We have determined the relative potency of rocuronium, pancuronium, pipecuronium and vecuronium, and examined the nature of the interaction of rocuronium with the other three steroidal neuromuscular blocking drugs. We studied the dose-response relationships of each drug and their combination with rocuronium in 200 ASA I or II patients during propofol-fentanyl-nitrous oxide-oxygen anaesthesia. Neuromuscular block was recorded as the evoked thenar mechanomyographic response to single twitch stimulation of the ulnar nerve at 10-s intervals. The dose-response curves were determined by probit analysis. Isobolographic and algebraic (fractional) analyses were used to assess the combined effect of equipotent doses of rocuronium and vecuronium, pipecuronium or pancuronium and to define the type of interaction between these drugs. The isobolograms were constructed by plotting single-drug ED50 points on the dose co-ordinates, and a combined ED50 point in the dose field. The calculated doses producing 50% depression (ED50) of the twitch height for rocuronium, pancuronium, pipecuronium and vecuronium were 144.8 (95% confidence intervals 140.4-149.3), 32.4 (31.7-32.9), 27.1 (26.5-27.6) and 23.7 (22.7-24.8) micrograms kg-1, respectively. Corresponding doses producing 95% depression (ED95) of twitch height were, respectively, 322.1 (307.5-337.3), 58.1 (56.2-60.1), 48.7 (46.9-50.5) and 39.9 (38.4-41.4) micrograms kg-1. Based on the estimate of ED50, the relative potency was 1:4.5:5.4:6, respectively. The interaction between rocuronium and vecuronium, pipecuronium or pancuronium was found to be additive.

Massive haemoptysis caused by congenital absence of a segment of inferior vena cava.

A patient with congenital absence of a part of the inferior vena cava is described. This resulted in spontaneous rupture of a bronchial vein leading to massive haemoptysis.

Retroperitoneal liposarcoma simulating a prolapsed intervertebral disc. A case report.

A metastatic liposarcoma presented with the clinical features of a prolapsed intervertebral disc. The tumour had spread from the retroperitoneal space in front of the sacrum by way of the first sacral foramen and along the dural sleeve of the first sacral root. Such a presentation has not previously been reported, and we make the point that it is important always to send material removed during operation on discs for histological examination.