Abdur Rauf Khan

Prosthetic materials and muscle flaps in the repair of extensive diaphragmatic defects: an experimental study

Relative merits of three methods of diaphragmatic hernia repair were evaluated in growing animals. Twenty-five puppies underwent laparotomy. In four controls, the left hemidiaphragm was incised and sutured primarily. In the remaining dogs, it was partially resected sparing the phrenic nerve. The defects were repaired in six with silastic sheeting, in eight with polytetrafluoroethylene (PTFE; trademark, Gore-Tex), and in seven with a thoracoabdominal muscle flap. Dogs were killed at 1, 4, and 7 months for gross and microscopic evaluation of the repair. Diaphragmatic function was evaluated by inspiratory force against a closed airway and by selective phrenic nerve stimulation (PNS). Serial fluoroscopy was used to evaluate diaphragmatic motion. Grossly the diaphragms in all groups showed compensatory growth. Microscopically the silastic was encapsulated without adherence, while PTFE showed tissue ingrowth. Maximal inspiratory force was equivalent in all groups but selective PNS revealed left-sided impairment in all experimental groups. Fluoroscopy showed paradoxical motion of the diaphragm in the muscle flap group for 1 to 2 months, and in the silastic repair group for 2 to 3 weeks, with near normal motion in the PTFE group for the entire postoperative period. These differences disappeared by 6 months. Prosthetic materials or muscle flaps are all safe for repair of large diaphragmatic hernias. Diaphragmatic growth occurs and the prosthesis remains in place. Physiologic impairment is minimal and not of clinical importance. Use of PTFE may be the preferred method as it develops better tissue incorporation and results in more normal diaphragmatic motion in the critical early postoperative period.

Childhood Esophagitis: Then and Now

Objectives: It is not known whether the prevalence of childhood esophagitis has changed over time. In children, the intraepithelial eosinophil is considered the hallmark of esophageal inflammation. This study compares the prevalence of intraepithelial eosinophils in esophageal biopsies obtained from 1980–1988 and 2001–2002. Patients and Methods: This study reevaluated all of the esophageal biopsies obtained at a single center during 2 periods: 1980–1988 and 2001–2002. Histological appearances were characterized and eosinophils per high-power field were quantified. Results: In total, 1058 esophageal biopsies from 510 subjects were reviewed. Between 1980 and 1988, 247 biopsies from 188 subjects were evaluated. Of these, 62 subjects met the criteria for esophageal disease, and 106 had no specific pathological changes. Between 2001 and 2002, 811 biopsies from 322 subjects were evaluated. Of these, 132 subjects met the criteria for esophageal disease, and 182 had no specific pathological changes. A statistically significant increase in the prevalence of esophageal inflammatory disease was observed comparing the recent group with the remote group. Eosinophilic esophagitis is thought to be distinct from other types of esophagitis in pathogenesis, epidemiology, histology, and treatment. Some suggest the prevalence of eosinophilic esophagitis has increased in recent years. We sought evidence for an increase in histological changes consistent with eosinophilic esophagitis. No matter whether histology consistent with eosinophilic esophagitis was defined as 25, 20, 15, or 10 eosinophils per high-power field, no increase in prevalence was found. Conclusions: This study demonstrated no evidence for a change in the density of eosinophilic infiltrates in esophageal biopsies during the 22-year study period. The study showed a statistically significant increase in the prevalence of esophageal inflammatory disease across the same period.

VALUE OF TOUCH PREPARATIONS (IMPRINTS) FOR DIAGNOSIS OF CUTANEOUS LEISHMANIASIS

Background. The clinical diagnosis of cutaneous leishmaniasis is confirmed by demonstrating the organism on a superficial smear or on a biopsy of the lesion. Misdiagnosis in a biopsy specimen may be due to scanty Leishmania organisms that may not be identified in histologic sections.

Three-month-old boy with juvenile granulosa cell tumor of testis and ossifying renal tumor of infancy.

We describe a 3-month-old male infant who presented with gross hematuria and was found to have a renal mass and a testicular mass representing these two entities. This is the first case report of these two lesions presenting concomitantly.

Advanced Glycation End Products Induce Obesity and Hepatosteatosis in CD-1 Wild-Type Mice

AGEs are a heterogeneous group of molecules formed from the nonenzymatic reaction of reducing sugars with free amino groups of proteins, lipids, and/or nucleic acids. AGEs have been shown to play a role in various conditions including cardiovascular disease and diabetes. In this study, we hypothesized that AGEs play a role in the “multiple hit hypothesis” of nonalcoholic fatty liver disease (NAFLD) and contribute to the pathogenesis of hepatosteatosis. We measured the effects of various mouse chows containing high or low AGE in the presence of high or low fat content on mouse weight and epididymal fat pads. We also measured the effects of these chows on the inflammatory response by measuring cytokine levels and myeloperoxidase activity levels on liver supernatants. We observed significant differences in weight gain and epididymal fat pad weights in the high AGE-high fat (HAGE-HF) versus the other groups. Leptin, TNF-α, IL-6, and myeloperoxidase (MPO) levels were significantly higher in the HAGE-HF group. We conclude that a diet containing high AGEs in the presence of high fat induces weight gain and hepatosteatosis in CD-1 mice. This may represent a model to study the role of AGEs in the pathogenesis of hepatosteatosis and steatohepatitis.

Peripheral lymphadenopathy as a primary presenting sign: A study of 324 cases from Asir region.

Superficial lymph node biopsies received over a four year-period, 1987 to 1990, at the histopathology laboratory of Asir Central Hospital wre reviewed. Total number of patients was 324, all presented with peripheral lymphadenopathy as the primary sign. Two hundred sixty-six patients (82%) were Saudi nationals and 58 patients (18%) were non-Saudi nationals living in Asir region. Granulomatous lymphadenitis was the most common pattern (43%) followed by: nonspecific lymphoid hyperplasia (33%), malignant lymphoma (13%), metastatic nonlymphoid malignant neoplasm (6.6%), and miscellaneous specific lymphadenopathies (4.4%). The distribution patterns of various histopathologic findings according to age, sex, nationality and lymph node location are included.

Biphasic malignant mesothelioma (malignant adenomatoid tumor) of paratesticular tissue

This article describes a metastasizing tumor of the paratesticular tissue which has features similar to that of malignant mesothelioma commonly seen in other mesothelial surfaces. The tumor is composed of two types of cells, epithelial-like and spindle-shaped malignant cells.

Of snakes and babies: intrathoracic stomach and vertebral rachischisis. A serpentine-like syndrome?

Snakes have intrathoracic stomachs and rachischisis-like spinal vertebrae. These anomalies are rare in babies and have not been previously described in combination in the English medical literature. Here we present 2 cases of total intrathoracic stomach with a foreshortened esophagus, cervical spine rachischisis, and splenic anomalies in newborns. Both had 46, XX karyotypes. The first case was initially treated with mobilization of the stomach into the abdomen. However, at 18 months the stomach was found to have retracted back into the thorax. Subsequently, the patient received a Collis gastroplasty and G-tube. Two-year follow-up is available. The second case exhibited the abovementioned anomalies along with absence of toes 3 and 4 on the right foot, and cardiac anomalies not compatible with life. The parents chose to withdraw support. The encountered abnormalities may be explained by a first trimester mesenchymal insult and share some similarities with the VACTERL association. In our experience, mobilization of the stomach into the abdomen without elongation of the esophagus will fail. If tolerated, the management of the intrathoracic stomach should include preoperative intragastric feedings to allow time for gastric enlargement followed by a Collis gastroplasty. The management of cervical rachischisis requires assessment of cervical spine stability and cervical immobilization. As other life-threatening birth defects may be present, thorough evaluation should be completed before counseling the families of the treatment options available.

An age- and gender-specific analysis of H. Pylori infection.

The objective of this study was to determine the incidence of Helicobacter pylori infection in different age and sex groups from the southern region of Saudi Arabia, and to relate the results to the high incidence of gastric cancer in this region. The carcinogenic effect of H. pylori is considered to be age-dependent. H. pylori infection early in life predisposes patients to gastric cancer. In contrast, acquisition of infection later in life leads to development of duodenal ulcer. We studied 528 consecutive endoscopic biopsies over a period from March 1995 to August 1996. The presence or absence of H. pylori was tabulated according to age and sex of the patients. Three hundred and fifty-three (67%) of 528 patients were positive for H. pylori. There were 313 males, among whom 217 (69%) were positive. There were 215 females, among whom 136 (63%) were positive for H. pylori. The presence of H. pylori in various age groups was as follows: under 16 years, 62%; 16 to 25 years, 67%; 26-35 years, 69%; 36-45 years, 67%; 46-55 years, 66%; and 56 years and above, 65%. Statistical analysis revealed no significant difference between the groups. No significant rise in the infection rate was noted from childhood to advanced age. These data support the belief that H. pylori infection was acquired early in life, leading to multifocal gastritis and thus predisposing the patients to gastric cancer later in life. However, H. pylori may not be the single agent of gastric cancer inasmuch as the infection affects both genders equally, whereas gastric cancer has a male preference. Perhaps some additional factors augment the pivotal role of H. pylori.

An Orthodontic Retainer Preventing Remission in Celiac Disease

Celiac disease is a gluten enteropathy that is treated with dietary elimination of gluten. Exposure to nondietary sources of gluten, which are used in the manufacture of products such as plastics, dental equipment, and cosmetics, can also trigger or exacerbate disease. We report the case of a 9-year-old child who presented with nonspecific abdominal discomfort with abnormal serology for celiac disease. She underwent duodenal biopsies that revealed Marsh 3B histopathology. Despite strict dietary elimination of gluten, she continued to be symptomatic and demonstrate positive serum markers for active disease. It was then discovered that the child was exposed to gluten from her orthodontic retainer that contained a plasticized methacrylate polymer. Gluten is a common additive in plastics. She discontinued its use and demonstrated symptom resolution and complete normalization of serology. All possible sources of gluten, including nondietary, must be considered when managing a child with celiac disease.