Talal Al-Malki

Gastrointestinal basidiobolomycosis: an emerging fungal infection causing bowel perforation in a child.

Basidiobolomycosis is an unusual fungal skin infection that rarely involves the gastrointestinal (GI) tract. We report a 10-year-old boy diagnosed as suffering GI basidiobolomycosis after being misdiagnosed first as suffering intestinal malignancy then schistosomiasis. The patient presented with fever, abdominal pain, vomiting, abdominal tenderness and rigidity with marked blood eosinophilia. Abdominal ultrasonographic and computed tomographic scans revealed a large caecal mass. Biopsy of the mass showed transmural granulomatous inflammation interpreted as schistosomal granuloma, ruling out lymphoma. The patients condition deteriorated despite anti-schistosomal therapy. Emergency surgery was then performed, and caecal perforation was found. The mass was excised; cultures were negative and histopathological examination was suggestive of schistosomal granuloma. The mass recurred 3 weeks post-operatively. Second-opinion histopathological examination diagnosed Basidiobolus ranarum infection. Treatment with itraconazole produced marked improvement, with diminution of the mass. B. ranarum was unequivocally identified in the archival formalin-fixed and paraffin-embedded (FFPE) tissue by PCR. This case emphasizes the need to consider GI basidiobolomycosis in children presenting with fever, abdominal mass and eosinophilia, especially those complicated by bowel perforation.

Scrotal appendicitis mimicking acute testicular torsion in a neonate.

According to Hemalatha and Spitz Diess described the first case of neonatal appendicitis in 1908 while the first neonatal case to survive surgery was reported in 1952 by Meigher and Lucas. Alvear and Rayfield found one case of scrotal appendicitis in a six-week-old infant in the literature before 1976 and also reported his own case in a five-year-old child. The prognosis in scrotal appendicitis in neonates is better than that of intra-abdominal appendicitis. This is due to early presentation diagnosis and localization of inflammation. In intra-abdominal appendicitis in infants and neonates there is a higher incidence of perforation and failure of localization and thus a high incidence of mortality. In our case the baby presented with acute painful scrotal swelling mimicking acute testicular torsion. A right inguinal hernia was not suspected preoperatively and appendectomy was performed through scrotal incision. (excerpt)

Medical and Surgical Management of Fecal Incontinence after Repair of High Imperforate Anus Anomalies

OBJECTIVE To report the medical and surgical management of fecal incontinence in children after repair of high imperforate anus. METHODS Thirty-seven children with fecal incontinence post repair of high imperforate anus were recruited between January 2000 and July 2007 at Aseer General Hospital, Abha, and Alhada Military Hospital, Taif, Kingdom of Saudi Arabia. The decision for surgery (dynamic graciloplasty) was based on the degree of incontinence and failure to respond to medical treatment. Five children were operated from the start according to the input of history, examination, and investigations (incontinence score of 15-20). The remaining 32 patients were treated medically. Those cases that failed to respond to medical treatment had alternatively biofeedback therapy. Cases that failed to respond to biofeedback therapy underwent surgery. RESULTS Response to medical treatment is favorable (71%). Biofeedback showed discouraging results (22%). Dynamic graciloplasty showed excellent outcome (100% improvement in continence on long term follow up). CONCLUSION Based on history, examination, and investigations, recruited cases were primarily treated medically; those who had failed the medical treatment approach had dynamic graciloplasty, which demonstrated excellent results during the 1-7 years follow-up period.

Metabolic efficacy of PHS-E 2 (Glucoherb), a chinese antidiabetic herbal health product, in Streptozotocin-induced diabetic wistar rats

Heshouwu (Polygonum multiflorum) and Dahuang (Rheum hotaoense) are Chinese vegetables. Preliminary studies in China showed hypoglycemic effect of the two plants extract mixture, PHS-E 2 (glucoherb). This study investigated the hypoglycemic efficacy of PHS-E 2 in comparison to that of glibenclamide in streptozotocin-induced diabetic rats. Glucoherb and glibenclamide were administered in rats orally, daily for a period of five weeks. Glucoherb was given at doses of 7 mg/kg, 15 mg/kg and 25 mg/kg. The comparable values of the three indices of cellular toxicity aspartate aminotransferase, alanine aminotransferase and bilirubin between glucoherb or glibenclamide treated rats and untreated normal control rats, suggest that glucoherb may not be toxic, at least to the liver, at the doses employed. The herbal preparation decreased the levels of total cholesterol and LDL cholesterol, in contrast to glibenclamide, which showed a tendency of total cholesterol increase at weeks 4 and 5 of the treatment. The daily oral administration of glucoherb, for five weeks at the three above doses was able to produce hypoglycemic effects between the second and the fourth weeks of treatment till the end of the experiment. The observed hypoglycemic effect was not dose dependant and was not different from that of glibenclamide in STZ-diabetic rats.

Common hepatic duct perforation in a sickle cell disease child.

The cause of biliary duct perforation is not well understood. Distal obstruction and/or congenital weakness of the common bile duct (CBD) are assumed to play a role.1 Idiopathic perforation is the second most common cause o f surgical jaundice in infants.2 The site o f perforation is always at the junction of the cystic and common hepatic duct. Bile duct perforation and choledochalcyst may be different manifestations o f a complex congenital biliary tract anomaly.3 Secondary perforation of the biliary duct due to CBD stones in a sickler child is rare and not previously reported.