[en] A 32-year-old Filipino female, working as an x-ray technician, presented to the Emergency Room (ER) with acute abdominal pain for one day. The pain was mainly on the left side and left hypochondrium. She had recurring abdominal pain before but not significant to worry her. She also complained of abdominal distension, which she noticed one week ago. Abdominal examination revealed fullness in the left hypochondrium with marked tenderness but negative rebound. Abdominal ultrasound (US) showed a huge mass mainly in the left hypochondrium. The origin of the mass cannot be identified by US. A computerized tomography scan showed a mass in the left side of the abdomen crossing the midline with a necrotic centre. The hospital course of the patient runs smoothly, and she was discharged after 7-days and referred to an Oncology Center. Abdominal mesothelioma is a neoplasm arising from the mesothelial surface lining the abdominal cavity. It is less frequent than that of the pleura. It is a rapidly growing and fatal malignancy with a median survival of less than 1-year. The relation between pleural malignant mesothelioma and asbestos is well recognized since it was described in 19602 but implication of asbestos exposure in the etiology of the peritoneal type is less obvious. This patient history is giving no obvious exposure to asbestos but as she is working in the Radiology Department as an x-ray technician she is well exposed to x-ray, but the effect of radioactivity on induction of mesothelioma is still disputed.4 There are several reports linking malignant mesothelioma to radioactivity due to radiation therapy.The fibrous mesothelioma (sarcomatous), as in this case, which is difficult to diagnose microscopically, looks like a fibroma, unless helped by tissue culture. The treatment options of malignant mesothelioma include surgery, intraperitoneal chemotherapy and whole abdominal radiation or multimodality therapy, which were suggested that might prolong the survival in patients with peritoneal mesothelioma.5 Although peritoneal mesothelioma is rare, progress in its management has occurred, survival has been extended and selection factors by which patients may be allocated to aggressive management strategies have been defined

[en] WE report a 60-year male patient with hepatocellular carcinoma (HCC) who presented with cutaneous metastatsis of the chest wall and ribs destruction. The tumor was advanced, and the patient died next day. (author)

[en] Skin cancer is a common malignant neoplasm in the Kingdom of Saudi Arabia (KSA) and it is the most common malignant neoplasm in Al-Baha area. This study was performed to determine the pattern of skin cancers seen at King Fahad Hospital, Al-Baha, KSA. Histologically diagnosed skin cancers, seen between 1990 and 2003, were reviewed and analyzed according to age, gender, race and site of distribution. Of a total of 193 patients, there were 79 (41%) cases of basal cell carcinoma (BCC), 56 (29%) cases of squamous cell carcinoma (SCC) and 34 (18%) cases of Kaposis sarcoma. Malignant melanomas represent 4.1% of the cases. The male to female ratio for all cancer was 1.6:1. The peak age distribution was in the 70-80-year group. The most common site involved in BCC was the head and neck (90%) and in Kaposis sarcoma were the lower limbs (59%). Acral distribution of malignant melanoma was seen in 62% cases. The most common skin cancers seen are BCC and SCC followed by Kaposis sarcoma. The site of distribution of BCC and SCC in our study is similar to studies in Caucasians. The site of distribution of BCC in sun exposed area supports the role of the ultraviolet light in the pathogenesis of such tumor. In contrast to the western countries, melanoma is a rare skin neoplasm in KSA. (author)

[en] Endometriosis of kidney is a rare manifestation of a relatively common disease. We report a case in which ovarian and renal endometriosis were diagnosed concurrently. The disease was probably silent for a long time due to coexistent thyrotoxicosis modifying estrogen metabolism. Fine needle aspiration cytology clinched the diagnosis of endometriosis and avoided unnecessary nephrectomy. (author)

[en] To investigate the morphology of chorionic villi using light and electron microscopy, especially the expression of alpha-fetoprotein (AFP) in trophoblastic cells and the process of maturation and margination vasculogenesis proper using CD34 immunohistochemistry in tissues from the first trimester of pregnancy loss due to anembryonic pregnancy in comparison with embryonic pregnancy. The study consisted of 2 groups: 9 patients with anembryonic pregnancies and 9 patients with embryonic pregnancies between 6 and 10 weeks of gestational age registered at the Department of Gynecology and Obstetrics, University Hospital of Karadeniz Technical University, Turkey, from March 2003 to December 2004. We examined the chorionic villi using light and electron microscopy. For immunohistochemical staining, we used AFP and CD 34. Microscopically, pathologic changes were shown in syncytiotrophoblast cells of anembryonic pregnancies and AFP was strongly expressed by villous trophoblastic cells compared to embryonic pregnancies. We determined the CD34 positivity in both groups. In anembryonic pregnancies, vascular elements were much fewer in number compared with embryonic pregnancies (p<0.001) and were located in the formed of hemangioblastic cords. Placental vasculogenesis is a basic feature in all types of pregnancy and a relationship exists between trophoblast cells and vessels in the chorionic villi with the potential to influence each other's functions. Defective chorionic villus vascularization is associated with embryonic death. This study may support the hypothesis, as suggested by previous studies, that anembryonic pregnancy results from early embryonic death and subsequent reabsorption rather than from the nondevelopment of an embryo. (author)

[en] To determine the prevalence of extended spectrum beta-lactamase among Enterobacteriaceae isolated from blood culture in a tertiary care hospital. We carried out this study at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia during the period between January 2003 - December 2004. We tested a total of 601 isolates of the family Enterobacteriaceae from blood culture for the prevalence of extended spectrum beta-lactamase (ESBL) production by the standardized disc diffusion method and confirmed by the ESBL E test strips. Ninety-five (15.8%) of the isolates were ESBL producers. Among these, 48.4% were Klebsiella pneumoniae (K. pneumoniae) followed by15.8% of both Escherichia coli (E. coli) and Enterobacter cloacae (Ent. cloacae). Other isolates produced ESBL in low numbers. Klebsiella pneumoniae produced ESBL in significant numbers. Extended spectrum beta-lactamase gram-negative bacilli present significant diagnostic and therapeutic challenges to the management of infections due to these organisms. Microbiology laboratories should start reporting ESBL producing Enterobacteriaceae organism due to their importance in respect to antibiotic therapy and infection control aspects. (author)

[en] To evaluate the immunomodulating effect of cyclophosphamide (Cy) on the course of Candida albicans (C. albicans). We performed this study in the Shiraz Medical School, Shiraz, Iran during April to November 2003. Five groups of 10 mice (vaccinated group) were immunized by 5 equal injections of 2x105, 2.5x105 and 3x105 of the organism intraperitoneally. Then, the group received Cy on day zero and was challenged with lethal doses of C. albicans (7.74x105 colony forming unit) on days zero, one, 3, 6 and 12 post-Cy injection. Another 5 equal groups of 10 mice (non-vaccinated group) received Cy on day zero and similar to vaccinated ones were challenged with lethal doses of the organism too. The control groups received just Cy on day zero and were sacrificed on days zero, one, 3, 6 and 12 days post-Cy injection. We performed the hemogram and the spleen and studied the renal tissues microscopically and macroscopically. In vaccinated group, we observed an increase in survival time and in spleen and renal weights were visible while in non-vaccinated ones, a significant decrease was also observed on days one and 3 and an increased on days 6 and 12 post-Cy injection. We observed atrophy and necrosis in the spleen while inflammation and necrosis were also observed in the kidneys on days one and 3. We noticed a significant hyperplasia in the white pulp on days 6 and 12 post-Cy injection. We conclude that hyperplasia in the white pulp of spleen and the increase in peripheral polymorphonuclears due to selective effects of Cy could effectively protect the animal against C. albicans infection. (author)

[en] The aim of this study is to evaluate the correlation between constitutional delayed growth (CDG) and mandibular bone trabeculation as well as bone density on panoramic radiographs using a computer software program. Panoramic radiographs obtained from 25 patients with CDG and 25 healthy adolescents were evaluated for this study. Patients were selected from admission to Hacettepe University, Faculty of Medicine, Section of Adolescent Medicine in the first half of the year 2002. All panoramic radiographs were taken under standard conditions, and were randomized and then converted to digital images for density analysis using a scanner. The images were transferred to Osiris computer software program for the evaluation of bone density from 4 different regions on the mandible (right and left mandibular angle and condyle). The CDG group had higher values for the risk of osteoporosis considering the right (t=3.360, p=0.002) and the left condyle (t=3.620, p=0.001) (t-test for independent samples). It was also seen that the CDG group was again at higher risk in comparison to the control group when left mandibular angle values were measured (z= -2.447, p=0.014) (Mann Whitney - U test). We suggest that panoramic radiographs, which are transformed into digital format, can be valuable and economic tools for detecting the risk of osteoporosis in adolescents with CDG. (author)

[en] The present study determines the degree of ossification of the posterior atlanto-occipital membrane in dry bone, plane lateral cervical spine radiographs and computer tomography (CT). The average length, width and the area of the arcuate foramen were measured on dry bone and on cervical CT. Further, age, gender and complaints of the patients of shoulder and arm pain, neck pain, headache, vertigo, and lacrimation in relation to the presence of bony complete or incomplete arcuate foramen were evaluated. From February 2004 to January 2005 60 dry atlases were obtained from the Anatomy Department, University of Marmara, Istanbul, Turkey and 416 lateral cervical spine radiographs were obtained from the Radiology department for neurological and orthopedic evaluations. Each complete arcuate foramen was calculated with the aid of Clemex Vision PE demo version computer program. Among the 60 dry atlases examined 7 (11.7%) had complete and 2 (3.3 %) had incomplete bony bridge formation. Of the 416 plane lateral cervical spine radiographs examined, 30 (7.2%) had complete and 26 (6.25%) had incomplete bony bridge formation. Of the 30 complete arcuate foramen 24 (80%) were females and 6 (20%) were males. The frequency of having a complete arcuate foramen in females was 8.45%, and in males it was 4.55%. Further, of the 26 incomplete arcuate foramen 20 (76.9%) were females and 6 (23.1%) were males. The frequency of having an incomplete arcuate foramen in females was 7%, and in males was 4.55%. The statistical evaluations showed that patients with complete arcuate foramen had significant complaints of shoulder-arm pain (p=0.0072), neck pain (p=0.0072) and vertigo (p=0.0598) compared to patients with incomplete arcuate foramen. The patients with complete arcuate foramen had a headache ratio of 12:30 and this ratio was 2:26 in patients with incomplete arcuate foramen and the difference between complete and incomplete arcuate foramen was statistically significant (p=0.0062). Further, no statistically significant relation was observed between both complete and incomplete arcuate foramen and lacrimation. No relationship between age and the presence of complete and incomplete arcuate foramen was observed. Presence of an arcuate foramen is always underestimated. Its presence should always be keep in mind in patients complaining of shoulder-arm and neck pain, headache and vertigo are examined. (author)

[en] In this study, we report a rare variation of the branching of the celiac trunk. During a routine abdominal dissection on a female cadaver, we found the celiac trunk to emerge from the abdominal aorta as 2 roots named hepatogastric trunk and hepatosplenic trunk. The hepatogastric trunk arises from the anterior surface of the abdominal aorta and divides into an aberrant branch to the right lobe of the liver, a branch to the right hemi diaphragm, the left hepatic and the left gastric arteries. The hepatosplenic trunk, which arises 1.5 cm below the hepatogastric trunk, gave off the common hepatic and splenic arteries. The common hepatic artery divided into the gastroduodenal, the right branch to the hepatic and the cystic arteries. It is important to know the variations of hepatogastric trunk and hepatosplenic trunk for the success of surgical operations to the liver and radiological investigations of those regions. (author)