Desmoid Tumor of the Rectus Abdominis with Urinary Bladder Involvement: A Case Report and Review of Literature.

Desmoid tumors (DTs) account for 3% of all soft tissue tumors. They are benign and have no malignant potential with a favorable prognosis, and predominantly occur in young women. The pathogenesis and clinical behavior of DTs are still uncertain. In addition, most cases of DTs were associated with abdominal trauma (including surgery), while genitourinary involvement seemed to be quite rare. Up to now, there has been only one DT case with urinary bladder involvement reported in the literature. We, Hereby, report a 67-year-old male patient with left lower abdominal pain while micturition. Computed tomography (CT) showed a mass located at the lower aspect of the left rectus muscle with an extension attached to the urinary bladder. Based on the pathological findings of tumor specimen, a diagnosis of benign desmoid tumor (DT) of the abdominal wall was made. Laparotomy with wide local excision was carried out. The patient had a smooth postoperative recovery and was discharged after 10 days. Introduction:Historically, MacFarland first described these tumors in 1832. Etymologically, the word desmoid was first coined by Muller in 1838 and is derived from the Greek word desmos, which means band or tendon-like. Stout first used the term fibromatosis in 1961[1,2,3]. Desmoid tumors (DTs) are a kind of rare neoplasm, which represents 3% of all soft tissue tumors and 0.03% of all neoplasms with an incidence of 5 to 6 per million of the population per annum[4,5,6]. DTs predominantly affect young females with a median age of 30 to 40 years old and is more than twice in female than male patients. However, there is no gender preference in older patients [7,8]. Furthermore, the symptoms of DTs are not typical in general. Symptoms can occasionally occur due to the size and location of the tumor but usually are nonspecific. Because of its rarity and unusual behavior, DT is often associated with diagnostic and therapeutic challenges. Computed tomography (CT) and magnetic resonance imaging (MRI) is beneficial for the diagnosis of this tumor but pathological diagnosis is mandatory. Surgical resection is now considered as the most efficient treatment option for patients with DT, because it offers a good chance of long-term survival. Our case is of unusual presentation and finding of abdominal wall desmoid tumor with an extension to urinary bladder in a male patient who is 67 years old. Keywords: desmoid tumor, fibromatosis, spindle cell tumor, urinary bladder.

Extradigital Glomangioma of the Cutaneous Chest Wall.

Glomus tumors (GTs) are rare benign tumors as a result of hyperplasia of glomus body. GT most commonly involves the subungual areas and rarely involves extra-digital sites. The clinical presentation of a glomus tumor is a triad of symptoms consisting of pain, cold intolerance, and pinpoint tenderness. Even though glomus tumors are benign, they can infrequently be malignant. Despite their benign nature, these lesions can cause disabling symptoms, therefore proper diagnosis and treatment is important. In this report, we present a 35-year-old Saudi male with a painful lesion on the right side of the chest wall at the posterior axillary line for seven years, with recent progressive growth and symptoms. Diagnosis of extra-digital glomangioma of the chest wall in this patient was confirmed by histopathology. The patient was managed by complete surgical excision of the lesion with the resolution of pain and without recurrence.

Age and long-term protective immunity in dogs and cats.

Vaccination can provide an immune response that is similar in duration to that following a natural infection. In general, adaptive immunity to viruses develops earliest and is highly effective. Such anti-viral immune responses often result in the development of sterile immunity and the duration of immunity (DOI) is often lifelong. In contrast, adaptive immunity to bacteria, fungi or parasites develops more slowly and the DOI is generally short compared with most systemic viral infections. Sterile immunity to these infectious agents is less commonly engendered. Old dogs and cats rarely die from vaccine-preventable infectious disease, especially when they have been vaccinated and immunized as young adults (i.e. between 16 weeks and 1 year of age). However, young animals do die, often because vaccines were either not given or not given at an appropriate age (e.g. too early in life in the presence of maternally derived antibody [MDA]). More animals need to be vaccinated to increase herd (population) immunity. The present study examines the DOI for core viral vaccines in dogs that had not been revaccinated for as long as 9 years. These animals had serum antibody to canine distemper virus (CDV), canine parvovirus type 2 (CPV-2) and canine adenovirus type-1 (CAV-1) at levels considered protective and when challenged with these viruses, the dogs resisted infection and/or disease. Thus, even a single dose of modified live virus (MLV) canine core vaccines (against CDV, cav-2 and cpv-2) or MLV feline core vaccines (against feline parvovirus [FPV], feline calicivirus [FCV] and feline herpesvirus [FHV]), when administered at 16 weeks or older, could provide long-term immunity in a very high percentage of animals, while also increasing herd immunity.

Cationic surfactant/bile salt interaction studied by fluorescence quenching.

Fluorescence quenching measurements were performed on aqueous solutions of the cationic surfactant cetyltrimethylammonium halide (CTAX) and two bile salts, sodium cholate (NaC) and sodium deoxycholate (NaDC), to study the state of aggregation in the mixtures. Pyrene was used as a photoluminiscence probe in the study, and dimethylbenzophenone (DMBP) as the quencher. Analysis of time-resolved decay data with and without quencher using a simple kinetic model gave information of the different aggregation characteristics in the above two cases. Mixed micelles of CTAX/NaC were small and spherical at all compositions, while those of CTAX/NaDC tended to grow from spherical micelles to larger rod-like mixed aggregates at equimolar and close-to-equimolar concentrations. In the latter case more complex kinetics ensues and the fluorescence decays were treated using a generatized model for diffusion-controlled quenching along one dimension for infinitely long rod-like micelles. The mutual diffusion coefficient for the probe-quencherpair was determined.

Comments on "The Cultural Conception and Structural Perpetuation of Female Subordination: an Examination of Gender Relations among the Populations of the Chalt-Chaprote Community in the Nager Valley of Northern Pakistan".

PIP: Commentary on the article on female subordination among the Chalt-Chaprote in northern Pakistan focused on the lack of uniqueness of the community profile and suggestions for improving the arguments. There were logical inconsistencies: that this community is no different in socioeconomic characteristics and in gender status from anywhere in Pakistan or southeast Asia. Access to formal education and health facilities is limited; there is low priority work, no decision making power, and a denial of rights of inheritance. This gender insubordination may not be due to the "gender hierarchy of supernatural forces." This community might be compared with another community which does not have the prevalent beliefs in the supernatural hierarchy. These beliefs in, for instance, the frailty of women may have been passed on in generations where bearing and rearing children meant dependence on men, which reinforced men's attitude of dominance. The second point made is that the calculation of women's productive work obfuscates the true picture of men and women's work; an example is given. The suggestion is to provide labor force participation rates. The final point is that men's only activities are excluded from the analysis and the focus is on agricultural and related activities. It would appear from the level of community development that there would be nonagricultural productive activity in the community: commerce, construction, teaching, and other services.^ieng

Female participation in housing activities: some assessment of the socio-economic and cultural impact.

PIP: Ordinary least squares techniques (logit and probit models yielded similar results) were used to assess the impact of sociocultural and economic conditions on women's physical or financial involvement in housing activities: construction, repairs, improvements, and additions in Pakistan. Explanatory variables were the number of men and women, family income, employment, literacy, extended family on the same or different budget, decision making by women, joint decision making, urbanization, and ethnic origin. Data were obtained from a survey undertaken by the AERC/World Bank in 1989 of 829 households (370 urban and 454 rural). A description is provided of women's role in housing, the nature of activities in which women participate, and the factors that influence their participation. Women's participation could involve decision making, contributions of assets or savings, and/or physical labor or supervision of physical construction of housing. The results indicated a uniform pattern in the performance of explanatory variables. Financially, urban women tended to participate more in financial dealings than rural women. Significant explanatory factors impacting on the proportion of women contributing financially toward housing were women's own income, their employment, their involvement in decision making for that activity, their nuclear household, and an urban location. A significant negative factor was family size. Literacy had no effect. Rural women tended to participate more in the physical construction of housing than urban women. Positive impacts on physical participation were a nuclear household, women's involvement in decision making, her employment, and a rural location. Literacy had a significant negative influence on physical participation. Unexpectedly, the number of adult females had a significant negative effect on physical or supervisory participation; the number of adult males was positive and insignificant. Factors influencing women's supervisory participation were women's employment and their involvement in decision making.^ieng

Features of non-insulin-dependent diabetes mellitus (NIDDM) in the Sudan.

413 NIDDM Sudanese patients were studied. The patients' ages at the onset of diabetes ranged from 20-72 years, with the majority of patients (44%) developing diabetes at the age between 40-50 years. Female to male ratio was 1.9:1. 46.2% of patients were obese and a family history of first degree relatives was obtained in 63% of patients. Complications of diabetes in this study were as follows: Neuropathy (31.5%), retinopathy (17.4%), cataract (16%), nephropathy (9.2%), coronary heart disease (5.1%), cerebrovascular disease (4.4%) and peripheral vascular disease (3.4%). Microangiopathic complications of diabetes were significantly related to the duration of diabetes and the degree of hyperglycaemia (P less than 0.001 using chi 2 test). Macroangiopathic complications were significantly related to aging and hyperglycaemia. Patients with good metabolic control (blood glucose less than 160 mg%) had less prevalence of complications than uncontrolled patients. We conclude that NIDDM is a common type of diabetes in our diabetic clinic. It is a disease with severe complications and morbidity and needs more attention regarding metabolic control, since good control reduces the prevalence of diabetic complications.

The use of plasma fructosamine in the assessment of diabetic control.

Plasma fructosamine and glycosylated haemoglobin were measured in insulin-dependent (n = 30) and in non-insulin-dependent diabetics (n = 90) and in healthy controls (n = 45). Fructosamine correlated significantly with glycosylated haemoglobin in the non-insulin dependent (r = 0.5, P less than 0.001) better than in the insulin-dependent group (r = 0.39, P less than 0.05). No correlation was found between plasma fructosamine and albumin or total protein concentrations when the concentrations of albumin and protein are within normal reference range. The fructosamine test has got many desirable characteristics, which will give it a role in the assessment of diabetic control.

Female participation in household decision-making: an analysis of consumer durables' acquisition in Pakistan.

PIP: Investigating the nature and degree of female household decision-making in Pakistan, this paper analyzes the influence of women in the purchase consumer durables. The paper also identifies those factors which enable women to play a more active role in the decision-making process. Because women in Pakistan are generally excluded from the public sphere, their level of emancipation is better assessed according to the degree of participation in household decision-making. A good measure of women's power within a household is their influence in the purchase of consumer durables (cars, appliances, etc.), whose expense and life-long nature makes their purchase an important decision. For this study, the authors relied on data from a 1989 nationwide household survey conducted by AERC, which included a information concerning the acquisition of 12 consumer durables as expected. As expected, men make more decisions on the purchase of all consumer goods than women, even for items in which women feel more need than men (e.g. sewing machines, washing machines). The study found that for the needs felt by women for all durable goods, men make 2/3 of all decisions, while women make only 1/3 of decisions. And in cases where the need is felt by men, the men make 93% of the decisions, while women decide only 3 % of the times. The study identified various cultural and economic factors that affect women's decision making power: urban women, women in nuclear families, educated women, and working women generally have more decision making power than rural women, women in extended families, illiterate women, and unemployed women.^ieng

Water goitrogens and endemic goitre in the Sudan.

The main cause of endemic goitre in the Sudan is dietary iodine deficiency. Water samples from four areas [Kass, Kosti, Wad Medani and Omdurman] two of which are known for endemic goitre did not appear to have any goitrogenic effect in our preliminary experiment using porcine thyroid follicle cell preparations.

Endoscopic retrograde cholangiopancreatography in Sudanese diabetics.

Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 40 Sudanese patients with diabetes mellitus. 25 were insulin-dependent and 15 were noninsulin-dependent. ERCP was normal in all the patients with insulin-dependent diabetes. Two patients with noninsulin-dependent diabetes had pancreatographic changes compatible with minimal-change pancreatitis. Diabetes mellitus in Sudan unlike in other tropical countries is not associated with structural changes in the exocrine pancreas.

A new focus of endemic goitre in the Sudan.

The prevalence of goitre in the town of Kosti, Central Sudan and the city of Khartoum was investigated on account of the increasing number of goitrous patients in the wards and out-patient clinics of Khartoum Hospital coming from the county of Kosti. The frequency of goitre among 7173 school children from Kosti was 74.8%, and was higher in girls (82.1%) than in boys (67.3%). The frequency among 7075 school-children of Khartoum was 17.5%. The mean urinary iodine excretion in subjects from Kosti was significantly lower (41.8 micrograms/g creatinine) than in those from Khartoum (83.6 micrograms/g creatinine) (p less than 0.001). The water content of iodine in Kosti was low (0.1 micrograms/1). There were no significant differences in the mean serum concentrations of triiodothyronine, thyroxine and thyroid stimulating hormone (TSH) between goitrous and non-goitrous subjects from Kosti. The mean serum level of TSH was higher in goitrous subjects from Kosti (5.2 +/- 1.4 mU/1) than in non-goitrous subjects from Khartoum. These data indicate a high prevalence of goitre in Central Sudan, mainly attributable to iodine deficiency, a fact which has not previously been recognized. Recent environmental goitrogenic factors might have modified the adaptation of the thyroid gland and promoted the occurrence of goitre.

Prophylaxis and treatment of endemic goitre in Western Sudan with intramuscular iodized oil.

A single injection of iodized oil was administered intramuscularly in a dose of 0.2-2 ml (475 mg iodine per ml) to 383 children from the villages of Kas and Dibbis of the Darfur region in Western Sudan, where goitre is prevalent. After one year the prevalence of goitre had declined from 76% to 49.6%. Of the goitrous children, 81.1% showed either complete resolution of goitre or definite regression of its size. None of the nongoitrous children developed goitre and none of the existing goitres became larger. No cases of hyper- or hypothyroidism were observed. The full 270 children were followed up for four-and-a-half years after treatment and compared with untreated controls from the same area. The prevalence of goitre was significantly lower in the treated than in the untreated group. In treated children the mean urinary iodine excretion three-and-a-half years after treatment was 188.7 micrograms/g creatinine. This was significantly higher than in the untreated group (P less than 0.001). One year later the mean urinary excretion of iodine in the treated children had decreased to 87.1 micrograms/g creatinine. There was no difference in the mean serum values of T3 and T4 in the treated and untreated groups. The level of thyroid stimulating hormone was significantly lower in the treated [mean (S.D.) = 3.5 (0.9)] than in the untreated children [6.0 (3.5)]. It is concluded that a single injection of iodized oil is safe and effective in prevention of goitre development, reduces goitre size and maintains a sufficient iodine supply to prevent goitre for at least four-and-a-half years in children from goitre-endemic areas in Western Sudan.

Trimethoprim-sulphamethoxazole in the treatment of enteric fever in the Sudan.

Patients with enteric fever confirmed by isolation of Salmonella species from blood culture, were treated with the combination of trimethoprim-sulphamethoxazole (co-trimoxazole). All 133 patients responded well to treatment. The mean defervescence was 2.74 days. No serious side effects were noticed and relapses occurred in the patients during the period of follow up.

HLA antigens and thyroid autoantibodies in patients with Graves' disease and their first degree relatives.

Patients with Graves' disease (n = 105) had an increased frequency of HLA-B8 (40%) and a reduced frequency of HLA-B12 (24.8%) when compared with random controls (n = 117; 24.8% and 40.2% respectively). Comparison of patients with their first degree relatives (n = 118) shows the frequency deviations in these antigens to be characteristic of the families from which patients with Graves' disease are drawn, rather than of the disease itself. The haplotypes, identified in eight-six patients and 113 relatives, indicate that the excess of HLA-B8 in patients and their relatives is primarily due to the halpotype 1-8. The relative risk for an HLA-B8 individual of developing Graves' disease is 2.02, whilst the relative risk for an individual of haplotype 1-8 is 4.23. No significant associations were found between the incidence of any HLA antigen or combination thereof and the presence or absence of thyroglobulin and thyroid microsomal antibodies, or antibodies which interact with the TSH receptor.