[Splenic nodules and sickle cell anemia]. / Nodules spléniques et drépanocytose.

OBJECTIVE: We report 4 patients with sickle cell anemia presenting with intra-splenic benign nodules corresponding to islands of preserved tissue within splenic ferro-calcinosis. MATERIAL AND METHODS: Ultrasound, CT and MRI findings were evaluated and compared to a follow-up study by ultrasound and CT done after 6 to 12 months. RESULTS: Ultrasound showed multiple well-defined rounded nodules appearing hypoechoic compared to the rest of the spleen that was hyperechoic. On CT, the nodules were homogenous, hypodense relative to the spleen, isodense to the liver in 3 cases and hypodense to the liver in 1 case. On MRI, the nodules appeared relatively hyperintense within low-signal-intensity spleens. The ultrasound and CT follow-up study demonstrated no remarkable change. CONCLUSION: In sickle cell patients, intra-splenic benign nodules corresponding to normal splenic tissue may be identified on imaging studies. The differential diagnosis is discussed.

Chronic duodenitis in Zaria, northern Nigeria.

Thirty-four consecutive patients presenting to the Endoscopy clinic of the Ahmadu Bello University Teaching Hospital, Zaria with symptoms of upper abdominal pain were investigated for chronic duodenitis by endoscopy and histology and for associated diseases. Twenty-two patients had histological evidence of chronic duodenitis. No clinical features separated these from those who had no duodenitis. Endoscopy was a good enough tool for diagnosis. Stool parasites were significantly commoner in those with histological duodenitis. Gastritis was also commoner in those with duodenitis. Ranitidine appeared superior to polycrol in relieving symptoms. Endoscopy is useful in the diagnosis of severe duodenitis. Specific ulcer healing drugs may be tried in treating symptoms associated with duodenitis, though their effectiveness is still open to further research.

Hepatocellular carcinoma: A clinicopathological analysis of 118 cases from Riyadh Central Hospital.

A review of 118 cases of histologically diagnosed hepatocellular carcinoma in Riyadh Central Hospital over a 15-year period from 1985 to 1989, showed that there were 73 Saudi nationals and 45 other nationalities. The overall sex ratio was 2.5;1, M:F (1.92:1 in Saudis; and 4:1 in other nationalities). The mean age for male Saudis was 61.2 years (range, 34-85) and for females 60.9 years (range, 18-80). Peak incidence occurred at 50 years for males and 60 years for females. Hemoperitoneum from ruptured tumor (7 cases) and 1 case of recurrent hypoglycemia were noted in the series. Tumor grading was Grade I, 10 (11.5%); Grade II, 49 (56.3%); Grade III, 28 (32.2%). Cirrhosis was associated with tumor in 58.0% of cases. Hepatitis B surface antigen was positive in 47.5% of Saudis and 47% in the whole group. Schistosomal serology was available in 21 cases and positive in 85.7%. The importance of hepatitis B virus in etiopathogenesis of hepatocellular carcinoma is reflected in this study.

Prevalence of antibodies to hepatitis C virus in Saudi and expatriate women in Riyadh, Saudi Arabia.

Six of 511 (1.17%) parturient Saudi females were positive for antibodies to hepatitis C virus (HCV), while one of 171 (0.58%) expatriate female nurses tested positive for the antibody. The prevalence of 1.17% in Saudis compares with 1.2% among pregnant women in Spain, while none of the 40 pregnant women screened in England tested positive for anti-HCV. Antibodies to hepatitis B core antigen in the same sample from Saudi women were positive in 24.6%. Judging by the low prevalence of its antibody, HCV is not as highly endemic as hepatitis B virus (HBV) in this population.

Prevalence of antibodies to hepatitis C virus in Saudi patients with chronic liver disease.

The prevalence of antibodies to hepatitis C virus (anti-HCV) has been measured in 113 Saudi patients with chronic liver diseases. Twenty-five percent of 20 patients with hepatocellular carcinoma (HCC) were positive for anti-HCV and 29.7% of 38 patients with cirrhosis and 27.3% of 33 patients with liver fibrosis, respectively, also tested positive. The positivity rate for a miscellany of liver diseases (22) was 13.6%. The differences between these prevalence rates were not statistically significant. By comparison, 45% of HCC tested positive for hepatitis B surface antigen (HBsAg) while 52.7% of cirrhosis cases were positive. There rates were statistically significant when compared with HBsAg positivity rates of 9.1% and 18.2% in the liver fibrosis and miscellaneous groups. The role of hepatitis C virus (HCV) may be secondary or additive in the causation of chronic liver disease and hepatocellular carcinoma in this environment in which hepatitis B virus (HBV) is highly endemic.

Prevalence of antibodies to hepatitis C virus in hemodialysis patients in Riyadh.

Prevalence of antibodies to hepatitis C virus (anti-HCV) was determined in 190 adults (mean age 40.4 years; range 15 to 75) with end-stage renal disease (ESRD) who are on regular hemodialysis in the Nephrology Unit, Riyadh Central Hospital. The overall prevalence rate was 53.7% (48.7% and 61.0% in Saudi's and expatriates, respectively). These figures are considerably higher than figures of 34.8% reported from hemodialysis units in Riyadh, 20% in Spain, 5.5% in Germany, and 1% in the United Kingdom. The possible reasons for the high prevalence of this marker of HCV in our hemodialysis unit are considered and suggestions made for its control.

Prevalence of antibodies to hepatitis C virus in blood donors in Riyadh.

Prevalence of antibodies to hepatitis C virus (anti-HCV) was determined in 580 voluntary blood donors in Riyadh. Among 403 Saudis screened, the prevalence was 1.24%, while among 177 expatriates screened the prevalence was 4.52%. The difference was statistically significant (P<0.02; x(2)test). The overall prevalence of 2.24% is lower than that reported in Spain (7.3%) but higher than reports from the United Kingdom (0.5 to 1%0, Italy (0.87%), or Germany (0.24 to 0.79%0. In view of reports that blood positive for anti-HCV can transmit non-A, non-B hepatitis, it is advisable to routinely screen donor blood for anti-HCV.

Upper gastrointestinal bleeding among Saudis: Etiology and prevalence the Riyadh Central Hospital experience.

Fiberoptic esophagastroduodenoscopic examination of 747 Saudi patients who presented with acute upper gastrointestinal (UGI) bleeding between January 184G to December 1986G showed that ruptured esophageal varices, erosive gastritis, duodenitis and peptic ulcer disease were the most common findings. There were 515 males and 232 females (M:F 2.2:1). Multiple lesions were detected in 83% of patients, emphasizing the need to anticipate more than one lesion at endoscopy in a patient with UGI bleeding. Sixty-seven patients (8.9%) gave a history of drug ingestion prior to the episode of bleeding; gastric and duodenal erosions were the most common lesions in these patients. No source of bleeding was apparent in 26 (3.5%) patients at the time of endoscopy. Endoscopy rather than barium studies has become established as the standard investigation in our patients with upper gastrointestinal bleeding.

Pattern of primary gastrointestinal tract malignancy among Saudi nationals: A retrospective study.

This histopathological reports from the central laboratory of Riyadh Central Hospital for between 1404 to 1406H (1984 to 1986) were reviewed retrospectively to determine the pattern of primary cancer of the gastrointestinal tract among Saudi nationals. During the study period, a total of 32,990 histopathological examinations were conducted. Neoplasms were identified in 4683 cases (14.2%); 1772 (37.8%) were malignant and 2911 (62.2%) were benign. The stomach (31%), liver (20%), and esophagus (19%) were the most commonly involved organs. The proportional frequencies of gastrointestinal malignancies differ from those seen in Western countries, although the age and sex distribution are similar. The possible etiological factors are discussed and the need for a cancer registry emphasized.

Upper gastrointestinal endoscopy in Zaria, northern Nigeria.

The indications for and findings in 431 consecutive patients who had upper gastrointestinal endoscopy in Zaria from June 1978 to August 1982 are reviewed. The major indications were dyspepsia (78.1%), upper gastro-intestinal bleeding (12.1%) and portal hypertension (4.2%). Other indications were persistent vomiting, dysphagia and abdominal masses. The mean age of the patients was 32 years. The male: female ratio (3:1) was not different from that in the hospital population. There were no abnormal findings in 32.7%. 26.6% had duodenal ulcers. Duodenitis was noted in 24.8%, oesophageal varices in 6.3%, gastritis in 6.3% and hiatus hernia in 4.6%. In those who presented with upper-gastrointestinal haemorrhage, oesophageal varices (34.6%) and peptic ulcer (17.3%) were the commonest findings. Complication seen commonly were soreness in the throat and thrombophlebitis at the site of valium injection. One death was recorded from the procedure over the period.

Evidence against the red blood cell origin of mitogenic factors in mouse malarial infection.

The mean [3H]thymidine incorporation in response to stimulation of spleen cells of malaria-immune and non-immune BALB/c mice by normal mouse red blood cell culture supernatants were compared with unstimulated cultures of the same spleen cells. No significant difference was obtained between stimulated and unstimulated cultures for both immune and non-immune spleen cells. These findings do not support the hypothesis that erythrocyte-derived mitogenic factors occur in malarial infection.

A case of blastomycosis from Zaria, Nigeria.

A case of blastomycosis from Zaria, Nigeria is reported. The clinical features were indistinguishable from those of tuberculosis which is very common in this environment. Lack of response to anti-tuberculosis therapy within eight weeks prompted the search for other organisms which resulted in the isolation of Blastomyces dermatitidis. Compatible histological evidence was obtained. Subsequent favourable response to amphotericin B was evident. Infection with this organism should be included in the differential diagnosis of pulmonary and pleural lesions simulating tuberculosis in West Africa.

The role of hepatitis B surface antigen in Nigerian children with nephrotic syndrome.

Hepatitis B surface antigen was detected by radioimmunoassay in the sera of 18 out of 50 (36%) children with nephrotic syndrome and in 28 of 61 (45.9%) controls. Immunofluorescent studies of kidney biopsies showed HBsAg, IgG, IgM and C3 deposits in a granular pattern in the biopsies of 12 children with nephrotic syndrome and in none of the control kidney biopsies, even though there was no significant difference between the frequencies of HBsAg in the sera of these two groups. We conclude that these findings are indicative of an aetiologic role for HBsAg in these patients.

Failure to induce splenomegaly in BALB/c mice using rodent malaria culture supernatants.

Uninfected male and female BALB/c mice were given a twice weekly intraperitoneal injection, of supernatants obtained from 24-h cultures of Plasmodium berghei-infected and control mouse red blood cells, for 5 weeks. The mice were then weighed along with uninjected controls. All the animals were sacrificed by chloroform anaesthesia and their spleen weights measured. Mice receiving malaria culture supernatants had statistically similar spleen weights to those receiving control culture supernatants. The results fail to show the involvement of a malaria 'mitogen' in the pathogenesis of the splenomegaly associated with this infection.

The nature of hepatic lymphocytic infiltrates in the tropical splenomegaly syndrome.

The lymphocytes infiltrating the liver of patients with tropical splenomegaly syndrome (TSS) were shown to be mainly T lymphocytes. Migration of leucocytes obtained from patients with TSS was inhibited by TSS liver extract, normal liver extract and liver-specific lipoprotein. These findings suggest that the hepatic infiltrates which occur in TSS are probably caused by a cell-mediated immune response to an antigen present in liver cells.