Ibrahim Al-Mofleh

Features of hepatic cavernous hemangioma on planar and SPECT Tc-99m-labeled red blood cell scintigraphy

PURPOSE To determine the value and diagnostic accuracy of planar and SPECT Tc-99m-labeled red blood cell (Tc-99m RBC) scintigraphy in the investigation of suspected hepatic cavernous hemangioma as found on ultrasound. PATIENTS AND METHODS One hundred patients, 89 women (89%) and 11 men (11%), between 22 and 67 years old (mean age, 38 years) were evaluated for liver masses found on abdominal ultrasound. All the patients had previous Tc-99m RBC scintigraphy. The size of the lesions ranged from 1 to 9 cm. The final diagnosis was reached through cytologic biopsy, or histopathologic tests (or all of these). RESULTS One hundred thirty lesions were found. With regard to the distribution of the lesions, 116 (89%) were single; 14 (3%) were multiple, with 118 (91%) in the right lobe and 12 (9%) in the left lobe; 83 (64%) were posterior; and 47 (36%) were anterior. With respect to the pattern of radioactivity fill-in, 86 (66%) lesions were typical and 44 (34%) were atypical. The results of Tc-99m RBC scintigraphy showed sensitivity, specificity, and positive and negative predictive and accuracy values of 97%, 83%, 98%, 77%, and 96% respectively. The use of SPECT improved the sensitivity value by 11% for lesions of 1 to 2 cm. CONCLUSIONS Tc-99m RBC scintigraphy is the noninvasive technique most helpful in the diagnosis of hepatic hemangioma, especially in those at risk for lesion rupture or bleeding. SPECT should be performed whenever planar imaging fails to show the lesion by 2 hours. The use of ultrasound should precede scintigraphy for two important reasons: the size and the location of the lesion. Location of the lesion (anterior or posterior) is important for optimal gamma camera acquisition parameters. Lesions less than 1 cm are cannot be detected because they are beyond the limit of spatial resolution of the gamma camera we used.

Combination chemotherapy for primary small intestinal lymphoma in the middle east

Twelve patients with primary small intestinal lymphoma were followed prospectively for 3 years. Endoscopic abnormalities were diagnostic of lymphoma in all cases where the duodenum was involved (83%). In three cases (25%) the disease extended to the stomach. One patient (8%) had diffuse small cell cleaved and 11 (92%) diffuse large cell lymphoma stages I (8%), II (25%), III (58%) and IV (8%). Nine of them were unresectable and primarily treated with combination chemotherapy; 67% achieved complete remission, 22% partial response and 11% no response. Only one patient relapsed and achieved a second remission. All complete remission patients are currently alive and free of disease at a median follow-up of 36 months. Overall survival for all patients is 58%, and disease-free survival is 50%. No instance of chemotherapy-related bleeding or perforation was seen. Tetracycline was necessary for the treatment of IPSID-associated diarrhea and malabsorption in spite of cytotoxic chemotherapy.

Tuberculous liver abscess: a case report and review of literature

Tuberculous liver abscess is rare worldwide. We report a 45-year-old man who presented with abdominal pain, fever and weight loss. Ultrasound and computed tomography of the abdomen showed multiple cystic lesions in the liver. Ultrasound guided needle aspiration revealed yellowish brownish aspirate, which was flooded with acid-fast bacilli. The abscess was drained under ultrasound guidance. Subsequent abdominal ultrasound a few days later showed resolution of the abscess cavity. He was concomitantly started on systemic antituberculous therapy. A tuberculous liver abscess has to be thought of in the differential diagnosis of liver abscesses and to consider the role of percutaneous drainage along with systemic antituberculous chemotherapy as an alternative to surgery in the management. A greater awareness of this clinical entity is required for successful treatment.

Gastric cancer in upper gastrointestinal endoscopy population: Prevalence and clinicopathological characteristics.

Over a period of seven years, 1404-1410H (1984-1990G), a total of 10,725 upper gastrointestinal endoscopies were performed at King Khalid University Hospital (KKUH), Riyadh. Sixty-seven patients (0.62%) had gastric adenocarcinoma. The endoscopy files of these patients were retrospectively reviewed. Men were more than three times at risk and their average age (61.1 years) was higher compared to women (49.1 years). Abdominal pain (49%), vomiting (36%) and weight loss (36%) were the dominating symptoms at presentation. Approximately 40% of gastric cancers were located at the cardiofundic region. The most frequent macroscopic type was the ulcerative type (67%). Polypoid (18%) and ulcerative-polypoid type (15%) were less frequent. According to Laurens [1] classification, 38% had diffuse, 51% interstitial, and 11% had intermediate type. Thirty-seven percent of the patients had an advanced lesion at presentation with organ metastasis.

Crohn's disease in Arabs.

Crohns disease is widely described in the Western literature, but it has not been widely observed in the Middle Eastern community. We diagnosed Crohns disease in seven Arabs, three whom were Saudi Nationals. Their mean age was 32.4 years (range, 18-40 years) and duration of symptoms varied from three months to ten years. The site of the disease was ileocolic in five patients and colonic in two. Mass lesions in the abdomen were seen in three patients. Four cases were diagnosed from histological specimens obtained at laparotomy and resection and the other three were diagnosed from colonoscopic biopsy specimens. Extraintestinal manifestations were found in three patients. Surgery alone was the treatment in two patients, whereas the remaining required medical therapy, mainly steroids, with or without surgery. We conclude that Crohns disease does occur in the Arab population, but with milder systemic effects.

Carcinoid syndrome without liver metastasis.

The carcinoid syndrome generally occurs due to metastasis of a carcinoid tumour in the liver. A patient is presented who had carcinoid syndrome due to abdominal disease without hepatic metastasis.

Praziquantel, oxamniquine, and metrifonate in the treatment of schistosomiasis in Riyadh.

This study sought to compare the effectiveness and side effects of praziquantel versus oxamniquine in treating 200 patients with Schistosoma mansoni infection and praziquantel versus metrifonate in...

Colonoscopy in Children

BACKGROUND Pediatric colonoscopy is routinely performed in most hospitals in Saudi Arabia and yet published data are scarce. The objective of this report is to describe our experience in the practice of pediatric colonoscopy in Saudi Arabia. PATIENTS AND METHODS Retrospective analysis of data of all patients below 18 years of age who underwent colonoscopy over a 10-year period. RESULTS From 1414 H (1993 G) to 1423 H (2002 G), two hundred and seventeen colonoscopies, of which 183 diagnostic procedures, were performed on 183 children. The majority (94%) were Saudi nationals, the age range was between 5 months and 18 years, and the female to male ratio was 1:0.8. Colonoscopy was total in 58 (32%) and limited in 125 patients (68%). The commonest reason for not completing the procedure was securing the diagnosis in 45/125 patients (36%). The commonest indication was rectal bleeding (35%). The highest yield was in children with bloody diarrhea (91%) and the lowest in those with abdominal pain (27%) with an overall yield of 44%. Colitis was the most common diagnosis occurring in 66% of the children. CONCLUSION this report highlights the role of colonoscopy in the recognition of diseases of the colon in our community and identifies some of the problems areas associated with the performance of this procedure in our institution.

Fever of Unknown Origin: Experience in Riyadh, Saudi Arabia

Fever of unknown origin constitutes a continual challenge to clinicians all over the world. The pattern of etiological factors varies from one geographic area to another. Over a 4-year period, 62 p...

Pediatric Esophagogastroduodenoscopy in Saudi Arabia

Seventy-two pediatric patients (44 females and 28 males) had esophagogastroduodenoscopy over a 2-year period. In 27 of 32 patients with a history of epigastric pain and heartburn, the endoscopy was...