Distribution of Kell antigens K, k, Kpa, and Kpb among blood donors in Jeddah city of Western Saudi Arabia.

CONTEXT: Kell blood group system is considered as the third clinically significant blood group in blood transfusion due to the highly immunogenetic of their antigens. No data are available regarding the frequencies of the Kell blood group antigens in Jeddah city. Knowledge of the antigen and phenotype frequencies is crucial to assess the risk of alloimmunization and to guide the probability of finding antigen-negative donor blood, which can be useful when blood transfusion is required for a patient who has multiple red cell alloantibodies. AIMS: The aim of this study was to determine the distribution of Kell blood group: K, k, Kpa, and Kpb antigens and phenotypes among blood donors in Jeddah city, western Saudi Arabia, to improve the transfusion services in the area. SUBJECTS AND METHODS: Seven hundred and fifty-eight blood samples from blood donors were used in the study. The samples were collected from different national blood bank centers in Jeddah city hospitals. Kell antigens were typed through gel card method using commercial antisera. STATISTICAL ANALYSIS USED: The gathered data were analyzed using the SPSS program. Frequency and crosstab tests were completed to achieve the objectives of the current study. RESULTS: The most frequent Kell phenotype in this study was Kp(a-b+), followed by K-k+, K+k+, and then Kp(a+b+), and the less frequent was K+k-. K-k- and Kp(a+b-) phenotypes were not observed in studied donors. CONCLUSIONS: This study is the first report to determine the frequency of Kell antigens and phenotypes among blood donors in Jeddah city. These results appear to be useful in providing better care for patients by implementing tests that should become a routine in blood banks. The Kell system is very important in transfusion medicine practice.

Intra-peritoneal leiomyoma of the round ligament in a patient with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.

BACKGROUND: The occurrence of an extra-uterine leiomyoma, arising from the intra-peritoneal portion of the round ligament in a lady with Müllerian agenesis diagnosed at the age of forty is extremely rare. We report a case of this rare combination in a Middle Eastern woman. CASE: A 40 years old lady, primarily amenorrheic, presented to our clinic for an infertility consultation. The work- up showed features suggestive of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome with a leiomyoma arising from the intra-peritoneal part of the round ligament.

Spreader graft placement in endonasal rhinoplasty: Technique and a review of 100 cases.

BACKGROUND: Spreader grafts are widely considered to be the mainstay of treatment for insufficient internal nasal valve and are commonly placed preventively during rhinoplasty, after hump removal, to avoid middle vault collapse. Although the placement and suturing of spreader grafts in open rhinoplasty is fairly easy, their positioning and stabilization in endonasal rhinoplasty is associated with a learning curve. METHODS: A review of the technique with tips for the novice surgeon is presented, particularly as pertains to correct placement. The technique can be used to insert spreader grafts irrespective of whether the nasal dorsum is addressed. Suturing is usually unnecessary. A retrospective review of 100 patients in whom spreader grafts were placed was undertaken to evaluate complications such as poor placement, displacement or other complications. RESULTS: Although there is a learning curve to ensure the dorsal mucosal attachment is maintained while developing the pocket sufficiently dorsally for proper graft placement, the technique is easy to learn, effective, quick and technically simple to perform. Of 100 patients, three had a cartilaginous dorsal spur as the cephalic edge of the graft became visible. One patient developed an ecchymosis along the dorsum that caused a hump that resolved in two months. There were no other aesthetic or functional complications. CONCLUSION: The endonasal placement technique provides for simple, safe and easy placement, as well as stabilization of spreader grafts during endonasal rhinoplasty, with few complications.

HISTORIQUE: Les greffes d'écarteur sont largement considérées comme le pilier du traitement lorsque la valve nasale interne est trop étroite. Elles sont souvent implantées de manière préventive pendant la rhinoplastie, pour éviter l'affaissement du septum après la correction d'une bosse. Même si l'implantation et la suture des écarteurs sont plutôt simples lors d'une rhinoplastie ouverte, leur mise en position et leur stabilisation s'associent à une courbe d'apprentissage pour la rhinoplastie endonasale. MÉTHODOLOGIE: Une analyse de la technique avec des pinces pour le chirurgien novice est présentée, particulièrement pour garantir une bonne implantation. On peut utiliser la technique pour implanter des écarteurs, même si on ne touche pas l'arête du nez. En général, les sutures sont inutiles. Les chercheurs ont entrepris une analyse rétrospective de 100 patients qui se sont fait implanter des écarteurs, afin d'évaluer des complications comme une mauvaise implantation, un déplacement ou d'autres problèmes. RÉSULTATS: Même s'il y a une courbe d'apprentissage pour s'assurer que la muqueuse de l'arête du nez est bien rattachée et développer suffisamment la poche de l'arête pour bien implanter la greffe, la technique est facile à apprendre, efficace, rapide et simple sur le plan technique. Sur les 100 patients, trois ont présenté un éperon cartilagineux tandis que le bord céphalique de la greffe devenait visible. Un patient a présenté une ecchymose le long de l'arête du nez, laquelle a causé une bosse qui a disparu au bout de deux mois. Aucune autre complication n'a touché l'esthétisme ou la fonction du nez. CONCLUSION: La technique d'implantation endonasale est simple, sécuritaire et facile. Elle permet de bien stabiliser les écarteurs pendant la rhinoplastie endonasale et provoque peu de complications.

Does pterygopalatine canal injection with local anaesthetic and adrenaline decrease bleeding during functional endoscopic sinus surgery?

OBJECTIVE: To determine the effect of pterygopalatine fossa injection with xylocaine and adrenaline on: surgical field bleeding and blood loss during functional endoscopic sinus surgery for chronic rhinosinusitis, and the duration of the procedure. METHODS: A prospective, single-blinded, controlled trial was performed in a tertiary care academic centre. A total of 45 patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis, whose disease was symmetrical based on computed tomography grading, were included. A unilateral pterygopalatine fossa injection with 1 per cent xylocaine and 1:100 000 adrenaline was performed after the induction of anaesthesia. The contralateral side served as the control. The operating surgeon, who was blinded to the injected side, assessed the surgical field using a validated six-item grading system. Blood loss, blood pressure, heart rate and end-tidal carbon dioxide were recorded every 15 minutes for each side separately, and duration of surgery was noted. RESULTS: There was no statistically significant difference in the surgical field grade between the injected and non-injected sides (p = 0.161). There were no differences in blood loss or duration of surgery. CONCLUSION: Pterygopalatine fossa injection prior to functional endoscopic sinus surgery did not decrease intra-operative surgical field bleeding, blood loss or duration of surgery.

Outcomes and cost benefits of functional endoscopic sinus surgery in severely asthmatic patients with chronic rhinosinusitis.

OBJECTIVES: To evaluate the outcomes (using validated outcome tools) and cost benefits of functional endoscopic sinus surgery in a population of severely asthmatic patients with chronic rhinosinusitis. METHODS: A prospective cohort study was conducted. The study comprised consecutive patients diagnosed with asthma and chronic rhinosinusitis for whom medical treatment had failed and who were scheduled for functional endoscopic sinus surgery. General health and disease-specific outcome questionnaires were completed pre- and post-operatively. Costs associated with both functional endoscopic sinus surgery and out-patient visits to a comprehensive asthma clinic were calculated. RESULTS: A total of 47 patients completed the surveys. The average improvement in Chronic Sinusitis Survey scores following functional endoscopic sinus surgery was 17 per cent. The average reduction in out-patient asthma clinic visits was 50 per cent, which translates to an average cost saving of $1035 Canadian dollars per patient per year. CONCLUSION: Functional endoscopic sinus surgery is a cost-effective treatment modality for asthmatic patients with chronic rhinosinusitis. This information is important for: the distribution and planning of resources, prioritising health programmes, and establishing practice guidelines.

Outcome of endoscopic sinus surgery for chronic rhinosinusitis patients: a Canadian experience.

OBJECTIVES: To determine the effect on patients' quality of life of functional endoscopic sinus surgery performed for chronic rhinosinusitis within a tertiary care centre in Montreal, Canada. METHODS: A prospective cohort study was undertaken. Subjects were consecutive patients with a diagnosis of chronic rhinosinusitis who had failed medical treatment and were undergoing functional endoscopic sinus surgery. Questionnaires assessing general health outcomes (i.e. the second version of the Short Form 12 questionnaire) and disease-specific outcomes (i.e. the Chronic Sinusitis Survey) were completed pre-operatively and a minimum of three months post-operatively. RESULTS: A total of 152 patients were enrolled over a seven-month period, of whom 120 completed the post-operative surveys. The most common co-morbidity was asthma (40 per cent). Of the 120 patients with completed questionnaires, 72 per cent reported clinical improvement, 12 per cent reported deterioration and 15 per cent remained unchanged. The average improvement in Chronic Sinusitis Survey score was 17 per cent. CONCLUSION: Patients with chronic rhinosinusitis achieved a significant improvement in disease-specific quality of life after functional endoscopic sinus surgery. There was no significant improvement in general health related quality of life, as measured using the Short Form 12 questionnaire.

Vestibular impairment in peripheral sensory neuropathies.

OBJECTIVE: Patients with peripheral sensory neuropathies frequently complain of dizziness, mainly unsteadiness, which occasionally seems to be more severe than the neuropathy. This study is an attempt to determine whether in cases where dizziness is a prominent feature the underlying cause is, at times, a concomitant vestibular dysfunction. METHOD: The files of 50 patients suffering from peripheral sensory neuropathies were retrospectively reviewed. Patients with central nervous system disease capable of inducing vestibular dysfunction were excluded from this study. In 47 of 50 patients, bithermal caloric tests were performed as part of electronystagmographic recordings. According to the caloric responses, these patients were divided into three groups: group 1: bilaterally reduced responses, group 2: unilaterally reduced responses, and group 3: normal symmetric responses. RESULTS: In 17 of 47 patients, the caloric responses were reduced bilaterally (group 1). In 8 of 47 patients, the responses were reduced unilaterally (group 2). In 22 of 47 patients, the caloric responses were normal and symmetric (group 3). CONCLUSION: Vestibular dysfunction was encountered in 25 of 47 patients (53.2%) suffering from peripheral sensory neuropathy. One wonders whether the pathologic process affecting the peripheral sensory nerves may also affect the vestibular nerve. This seems possible in view of the fact that the vestibular nerve, a sensory nerve itself, has a histologic structure similar to the peripheral sensory nerves.

Squamous cell carcinoma of the nasal vestibule.

Squamous cell carcinoma of the nasal vestibule is a rare disease. Most advocate radiotherapy as a primary treatment for early tumours, with surgery reserved for salvage. For advanced disease, combined therapy with surgery and postoperative radiotherapy is generally recommended. Fourteen patients with squamous cell carcinoma of the nasal vestibule were reviewed. A classification of early versus late lesions was used. We achieved a 78% local regional control rate (minimum follow-up 3 years) in patients with early disease, with either radiotherapy or surgery as a primary modality of treatment. All patients with late disease recurred, requiring further surgical and/or radiation treatment. Only 20% of these patients were disease free at 2 years. Recurrent disease in either group, whether local or regional, carried a grave prognosis, with a 25% disease-free survival at 3 years.

Sino-orbital foreign body in a child.

Foreign bodies of the sinuses are uncommon. Few reports exist in the English literature. Among these, the frontal and maxillary sinuses are most often involved. Ethmoid and sphenoid foreign bodies are rare and tend to present with chronic symptoms due to delayed diagnosis. We present a case of an acute presentation of a foreign body involving the orbit and ethmoid sinus in a 12-year-old male.

Effects of capsaicin and capsaicin desensitization on alanine accumulation in rat hemidiaphragms.

1. Alanine accumulation in rat hemidiaphragms is significantly inhibited by capsaicin in a dose-dependent pattern that produced maximal effect at 1 mM. 2. The inhibitory effect of capsaicin on alanine accumulation by rat hemidiaphragms was enhanced upon preincubation with 5 mM ouabain. However, preincubation with 1 mM Verapamil did not alter the inhibitory effect of capsaicin. 3. Chemical ablation of the capsaicin-sensitive primary afferent fibers abolished the inhibitory effect of capsaicin on alanine accumulation in the rat hemidiaphragms.

Prevalence and patient profile in activated protein C resistance.

Activated protein C resistance (APC-R) is a recently defined abnormality of the coagulation system predisposing to the development of a hypercoagulable state. The authors have attempted to evaluate the prevalence and clinical manifestation of APC-R by studying a population of 183 patients with a history of venous thromboembolic episodes. Laboratory evaluation of APC-R was performed using the test initially described by Dahlbäck and colleagues based on the activated partial thromboplastin time (APTT) with the Coatest APC resistance kit (Chromogenix, Sweden) on KC10 coagulometer (Amelung, Germany). These results showed a 13% prevalence of APC-R as demonstrated by an APC ratio below 2.0. The male-to-female ratio was 1:7. Most of the thrombotic episodes were deep venous thromboses (50%).

Bilateral synchronous testicular germ cell cancer.

Bilateral synchronous testicular cancer is a rare occurrence usually associated with similar histologic findings in each testicle. We describe eight patients with bilateral synchronous testicular germ cell cancer, of whom four had dissimilar histologic findings. Contralateral disease in three patients was identified only by testicular ultrasonography or intraoperative exploration of the contralateral testicle, and in two cases by palpation 6 months after identification of the primary cancer. Treatment was determined by conventional staging and five of eight patients have remained free of recurrent disease.

[Resistance to activated protein C in venous thromboembolic complications. Incidence and clinical manifestations]. / Résistance à la protéine C activée dans les accidents thrombo-emboliques veineux. Fréquence et manifestations cliniques.

OBJECTIVES: The frequency of activated protein C resistance is not well established for patients with venous thromboembolic disease. We studied resistance to activated protein C in patients with a past history of deep vein or superficial vein thrombosis. METHODS: Activated protein C resistance was measured in 175 patients (37 males, 138 females; mean age 40.9 +/- 13.8 years; range 15-77) who had suffered a venous thromboembolic event more than one month earlier. Exclusion criteria were malignancy, known autoimmune disease or known coagulopathy. A control population of 50 healthy subjects were also tested to establish a normal lower limit (mean ratio minus 2 SD). RESULTS: The lower limit was established at 2.14. According to this definition, there were 29 thromboembolic patients who were resistant to activated C protein (17%). Two of the subjects considered healthy in the control group were also resistant (4%). There was no difference for age or sex between resistant and non-resistant subjects. Comparing our findings with those reported in the literature confirmed that 3 to 5% of healthy subjects and 15 to 25% of patients with history of venous thromboembolism are resistant to activated C protein. CONCLUSION: Resistance to activated C protein thus appears as a risk factor for thrombotic events which is comparatively more frequent than other causes of thrombotic disease.

Paratubal cysts: frequency, histogenesis, and associated clinical features.

A review of 79 cystic lesions found in the routine study of the fallopian tube and its surrounding areas between the years 1980 and 1982, revealed that the majority of the lesions represented accessory lumina of the fallopian tube. These tubal cysts commonly have been described as hydatids or parovarian cysts, but their relationship to the normal tube has not been identified clearly, their frequency has not been determined, their clinical significance rarely has been considered, and their embryologic origin remains imperfectly understood.