The diagnostic challenge of pulmonary Kaposi's sarcoma with pulmonary tuberculosis in a renal transplant recipient: a case report.

We report a case of a 39-year-old, HIV-negative, post renal transplant patient who developed mucocutaneous Kaposi's sarcoma with lung parenchymal involvement and concurrently culture proven pulmonary tuberculosis. To the best of our knowledge, this is the first case report of this combination, which presented with cavitating lung nodules and responded well to withdrawal of immunosuppressive drugs beside antituberculous treatment.

Bochdalek hernia in adulthood: a case report and review of recent literature.

A 37-year-old Filipino woman presented with a post road-traffic accident fracture of dorsal spine 12. Chest radiograph revealed evidence of loops of small bowel in the left lung field. She admitted to symptoms of respiratory insufficiency since birth and treatment for tuberculosis in childhood. A pre-operative diagnosis of left traumatic diaphragmatic hernia was not confirmed at laparotomy which revealed typical left congenital Bochdalek hernia with smooth edges and herniation of small bowel and spleen into the left pleural cavity. Following reduction and repair of the hernia, the patient made an uneventful recovery. Chest radiograph remains normal till now, eight years post-operatively.

Unusual presentations of injury to the bronchus with literature review.

Two patients with unusual presentation of injury to the bronchi are discussed. The first had a gun shot wound of the anterior left chest with the bullet ricocheting across to the right hemithorax and puncturing the right mainstem bronchus resulting in right massive pneumothorax and subcutaneous emphysema. The second suffered a blunt thoracic trauma from a road traffic accident and presented with bilateral rib fractures and bilateral pneumothoraces treated with bilateral closed thoracostomy tube drainage. Bronchofiberscopy revealed complete transection of the left mainstem bronchus.

Bronchial carcinoid tumours in southern Saudi Arabia.

Clinical presentation, pathology, surgical management and follow-up of ten bronchial carcinoid tumour (BCT) patients are described. There were five male and five female patients with age range between 5 to 85 years (mean 39.2 +/- 21.5, SD). Pathology revealed BCT on the right side in seven and on left side in three patients. The tumour was an incidental finding in four while the other six had respiratory symptoms. Cough was present in all of the later group and hemoptysis was present in four patients. Recurrent chest infections were seen in two patients. Symptoms ranged from 1 week to 15 years. Successful surgical resection was done in nine with the longest follow-up of 80 months (mean: 23 months +/- 26.3, SD) without recurrence or metastasis. Histopathological examination of these tumours revealed classical morphological features in all but one case. Grimelius stain positivity for argyrophilia confirmed the diagnosis in all the patients in this study. Electron microscopic examination was done in patient no. 9 which showed atypical morphological features and neurosecretory granules. BCT may present like pneumonias or bronchial asthma. Although BCTs have low-grade malignancy, early diagnosis and surgical resection yield curative results almost in all cases.

Intestinal obstruction in a Saudi Arabian population.

In a six-year period, fifty-six cases of intestinal obstruction seen and treated at Asir Central Hospital since its inception were analysed. Adhesions from previous laparotomy scar constituted the commonest cause of intestinal obstruction (57.1%). A distant second is faecal impaction (7.1%). Previously performed appendicectomy is the commonest cause of adhesions causing intestinal obstruction. The interval between surgery and intestinal obstruction varies from one month to three years. The pattern of intestinal obstruction seen in this environment is more similar to those in the western World or advanced countries, than the pattern in the developing countries. This can be explained on the basis of the fact that, even though Saudi Arabia is a developing country, the health care delivery system is similar to those in developed countries. Fifty percent of intestinal obstruction due to adhesions were managed successfully by conservative treatment only. About 15% had a failed conservative treatment and had to undergo operation. In those cases that required exploration and lysis of adhesions, 43.8% also required bowel resection and re-anastomosis.

Spontaneous pneumothorax: A retrospective study of twenty-five patients and literature review.

We present a retrospective study of 25 patients with spontaneous pneumothorax (three current), comprising 16 Saudis (nine males and seven females) and nine non-Saudis (eight males and one female), seen at the Asir Central Hospital, Abha, over a period of 45 months. Almost one-third of the patients (9/25) had no underlying cause discernible by our investigational facilities (chest x-ray, ultrasonography, computed tomographic scan, and flexible bronchofiberscopy). Underlying pneumonia (three patients), pulmonary tuberculosis (two patients), lung abscess (one patient), and congenital bullae (one patient) constituted the etiology in another third of the spontaneous pneumothorax patients. Other underlying pulmonary diseases precipitating spontaneous pneumothorax in the group included pulmonary fibrosis, metastatic mesothelioma, and immunosuppression in a medulloblastoma patient undergoing chemotherapy with the development of chickenpox. Closed thoracostomy tube drainage was the only method of treatment in 20 out of the 25 patients, with three failures of closed thoracostomy tube drainage needing thoracotomy and resection of blebs/bullae. The only complication was empyema in two of the patients. Two patients were successfully treated conservatively with observation alone.

Sternal fracture - regional experience.

A retrospective analysis of 27 sternal fracture patients out of 267 patients with chest trauma was done in the period between March 1990 (9-1410) and April 1994 (11-1414) at Asir Central Hospital, giving an incidence of 10% in all chest trauma. There were 25 males and two females, giving a ratio of 12.5:1. The age range was 18-70, with a mean age of 37.5 years and a median age of 35 years. The mean hospital stay was 12.2 days, with a range of 3 to 53 days and a median of seven days. The mechanism of injury and the types of associated injuries are presented. Twenty-eight percent of the sternal fracture patients had abnormal electrocardiogram. Echocardiogram was done on only eight patients (32%); two were abnormal.

Analysis of 303 road traffic accident victims seen dead on arrival at emergency room-assir central hospital.

BACKGROUND: Although Rood Traffic Accident (RTA) is a noticeable common cause of death in Saudi Arabia, there is no published data showing the relative frequency of this disease as a cause of death. AIM OF THE STUDY: This study attempted to find out the relative frequency of RTA as a cause of death. Also, to identify age groups at risk as well as make some inferences from the different types of injuries seen. METHODOLOGY: In a period of over a four and half years, 574 patients were seen dead on arrival at the Emergency Department of Assir Central Hospital, Abha, Saudi Arabia. Of these, 303 (52.8%) were victims of RTA. RESULTS: The 303 victims revealed a male to female ratio of 14:1, Saudi nationals of 69% and age range of 3 months - 85 years (mean = 34.25 years). The peak age group was between 21 and 49 years and the peak period of presentation at the Emergency Department was between 12:00 noon and 18:00 hours. The month of ten in Hegira Calendar represented the peak period; a significant (P<0.05) seasonal variations was also seen, summer being the highest. Clinical assessment of the victims revealed that head and neck injuries were the commonest followed by chest injuries. CONCLUSION: RTA is the primary cause of death among dead on arrival cases affecting the most active and productive age group. The study recommended the implementation of pre -hospital emergency medical system.

Empyema thoracis in adults in Saudi Arabia.

Empyema thoracis in adults is an uncommon disease in the Asir region of Saudi Arabia. In a period of seven years (1988 to 1994), 24 patients were treated for empyema thoracis with a hospital incidence of about 23 patients in 100,000 admissions. The community acquired empyemas are more common and less aggressive in non-Saudi patients (six males and one female) as compared to Saudi patients (11 males and 6 females) whose empyemas are mostly nosocomial with an aggressive course. The peak age in both Saudi and non-Saudi patients is 45 years and 25 years respectively, and the right pleura is more commonly affected than the left pleura in both groups. Risk factors include diabetes mellitus, pulmonary tuberculosis, post-pneumonectomy infections, trauma and pneumonia. The commonest organisms grown are Pseudomonas aeruginosa, Klebsiella species and Staphylococcus aureus, although in almost 40% of the patients the empyemas were sterile. The commonest method of treatment was closed thoracostomy tube drainage.

Acute appendicitis in females--a clinical study of 366 cases.

A study was carried out on 366 female patients admitted consecutively to Asir Central Hospital with clinical diagnosis of acute appendicitis during the period between 1988 through 1991. In this study, 271 patients had histopathologically proven appendicitis for a diagnostic accuracy of 74%. Ninety-five (26%) patients did not have appendicitis, however, 27 (7.4%) of them had other disorders indicating surgical intervention. Consequently, 18.6% of the patients studied had negative laparotomy. This study showed insignificant (P > 0.05) relation between age, site of pain and its duration, presence of urinary symptoms, post-operative complications and hospitalization in one hand, and the final diagnosis on the other hand. The marital status, the presence of gynaecological symptoms, white blood cells count, neutrophils and lymphocytes percentages were, however, significantly related to the final diagnosis (P < 0.05). A conservative approach with in-hospital observation and repeated clinical examination of the doubted appendicitis cases are recommended so as to reduce the rate of the negative laparotomy with its considerable complications.

Topical ampicillin for prophylaxis against wound infection in acute appendicitis.

A total of 249 patients, undergoing appendectomy for acute appendicitis, were prospectively randomized into two groups. Group I, comprising 132 patients, received sterile normal saline irrigation to the surgical wound at closure. Alternatively, Group II included 117 patients, who received intraoperative topical ampicillin irrigation of the wound. Both groups were comparable with regard to age, sex, duration of symptoms, and severity of appendicitis. All patients additionally received preoperative systemic gentamicin and Flagyl. Wound infection occurred in 5.3% of Group I compared to only 0.9% of Group II (P<0.05). The reduction in infection rate was significant (P<0.05) in histologically proven appendicitis. We conclude that the addition of intraoperative topical ampicillin to systemic gentamicin and Flagyl augments prophylaxis against wound infection in acute appendicitis.