Recurrence of dermatofibrosarcoma protuberans: a case report and a review of literature.

A 46-year-old Saudi male underwent excision of right anterior upper chest wall lesions. On histopathological examination, the lesion was thought to be dermatofibroma. Nine years later, he presented with a recurrence at the site of excision. Review of previous studies and histopathological examination of the recurrent lesion was suggestive of dermatofibrosarcoma protuberans. He underwent wide excision with satisfactory results.

Gunshot injuries in adults in the Abha region of Saudi Arabia.

In the four-year period from 1996 to 1999, 42 adult patients (age 12 years and above) were admitted to the Assir Central Hospital, Abha, Saudi Arabia, following gunshot injuries. The mean annual admissions for gunshot injuries was 10.5 +/- 4.04 (range = 8-16 cases/annum). All the patients were males. The distribution of the patients' nationalities were: Saudis 66.7%, Yemenis 11.9%, Ethiopians 11.9%, Eritreans 7.1% and Sudanis 2.4%. In 38 cases, others shot the patient, while only one patient (2.4%) admitted to shooting himself accidentally. A pistol was used in 81% of cases while an air gun was used in 9.5% of the cases. Wound of entry analysis showed that gunshots were to the lower limbs in 20 cases (47.2%), the upper limbs in 22% and the chest in 13% of cases. Gunshots to the head and neck occurred in 7% and 2% of cases, respectively, while the abdomen was hit in 4% of cases. The injuries sustained included: superficial wounds (64.3%), haemothorax (9.5%), nerve injury (9.5%), lower limb fractures (9.5%), haematoma (7.1%), liver and kidney injuries (2.4%, respectively). Management included wound debridement and suturing (76.2%), thoracostomy tube drainage (14.3%), bullet removal (11.9%), internal fixation of fractures of long bones (9.5%), laparotomy and repair of gut (7.1%), nerve repair (4.8%), ulnar nerve graft (2.4%), and external fixation compound fracture of the tibia (2.4%). All the patients survived. The mean hospital stay was 15.45 +/- 23.06 days (range = 1-150 days). Although gunshot injuries are increasingly being reported from Saudi Arabia, the injuries are accidental and the morbidity appears to be low.

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.

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.

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.

Infected abdominal aortic grafts.

Aortic grafts were inserted in 1711 patients at Ottawa Civic Hospital (OCH) between 1976 and 1986. Aorto-iliac occlusive disease was the indication in 884 while in 827, the graft was inserted for abdominal aortic aneurysms. Graft infection occurred in 12 patients; six presenting with gastrointestinal bleeding due to aorto-enteric fistula (AEF) and the other six presenting with groin abscesses, mostly as a draining sinus. These were treated with graft excision and immediate extra-anatomic bypass. Seven patients died, giving a mortality rate of 58%. Three surviving patients required above-knee amputatio. These results are comparable to the results of others in the literature; therefore, continuing assessment of all aspects of graft infection and the search for more effective methods of prevention and management are needed.