Tarek Malatani

Khat and oral cancer.

Oral cancers in the Asir region of Saudi Arabia have been observed to occur mostly among patients who have been long-term khat users. In a survey that reviewed cancers for the past two years there were 28 head and neck cancer patients, 10 of whom presented with a history of having chewed khat. One of these was a case of metastatic cervical lymph node and unknown primary, one was a parotid tumour, and the remaining eight presented with oral cancers. All were non-smoking khat chewers and all of them had used it over a period of 25 years or longer. We conclude that this strong correlation between khat chewing and oral cancer warrants attention.

Enterobius vermicularis (pin worm) causing symptoms of appendicitis

Continued from p 177 Malaria Retinal findingspredictiveof outcome in cerebral malaria Research in Malawi concentrated on the direct and indirect ophthalmoscope examinations of 141 Malawian children with strictly defined cerebral malaria. Two distinct and prognostically significant findings were identified, papilloedema and extramacular retinal oedema. The relative risk of death in patients with papilloedema was nearly seven times greater than those without papilloedema and extramacular retinal oedema was associated with a nearly threefold increase in the relative risk of dying. The mortality rate in patients with none of these signs was only 1.3% compared to an overall mortality rate of 9.2%. Extramacular retinal oedema was identified by finding discrete areas of intra-retinal opacification sometimes occurring within the macular area or outside it. Whilst this generally occurred in discrete spots they sometimes coalesced to give large areas of retinal whitening deep to the retinal vessels. The authors believe that this sign is unique to cerebral malaria, not having observed it over a period of 4 years examining Malawian children with other conditions. Based on these findings the authors suggest that two pathways to poor outcome may exist in children, one with increased intracranial pressure manifesting as papilloedema and the other 183 symptoms of appendicitis making even the most experienced surgeon operate in such cases. These clinical features are independent of any histopathological changes of the wall of the appendix, but are dependent on the presence of a foreign body in the lumen of the appendix. In this case the most significant findings histopathologically were the presence of the worm, and haemorrhage within the lumen of the appendix. Surgical intervention was necessary to make the diagnosis.

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.

Peripheral T-cell lymphoma with unique immunologic features.

Background. The autologous mixed lymphocyte reaction (AMLR) is an important immunoregulatory phenomenon in human immune disorders. The authors have determined the phenotype and assessed the response of malignant lymph node T‐cells, from histologically and immunologically proven cases of peripheral T‐cell lymphoma, in AMLR and allogeneic mixed lymphocyte reaction (MLR) and studied the secretion of lymphokines.

Head and neck cancer in a referral center in Asir region.

This study looks at the incidence of head and neck cancer in the Southwest Region of the Kingdom of Saudi Arabia (Asir Region). There were a total of 204 newly diagnosed patients seen at Asir Central Hospital between 1987 and 1992; 113 males and 91 females. All were Saudi patients. Frequency at various sites with reference to sex and age was determined and comparison with local and international published reports was made. To the best of our knowledge, this is the first paper in the Kingdom to look at head and neck cancer as a distinct entity. In this study, skin cancer was the most common among males followed by oral and pharyngeal cancers. Among females, thyroid cancer was the most common followed by skin and oral cancers. Some preventive measures are discussed.

Pattern of primary gastrointestinal tract cancer in the southern province.

Two hundred thirty-four cases of primary gastrointestinal tract malignancy were diagnosed at the histopathology laboratory of Asir Central Hospital over a four-year period, from 1987 to 1990. The current study is a retrospective analysis of these cases regarding rank orders, distribution according to nationality, age and sex, primary sites affected and the histopathologic pattern. Eighty-eight percent of our cases were Saudi and 12% were non-Saudi nationals. The mean age of patients was 60 +/- 16 years with a male:female ratio of 2:1. Primary liver cancer was the most common malignancy (29%), followed by gastric cancer (27%), colorectal cancer (21%) and esophageal cancer (13%). Comparison of our findings to those from other provinces of the Kingdom are also included.

Surgical audit: A prospective study of the morbidity and mortality of acute appendicitis.

Between March and September 1989, acute apendicitis was clinically diagnosed in 317 patients who were studied as part of a prospective surgical audit. The study was designed to determine the accuracy of diagnosis, comparison of the macroscopic appearance of the appendix at operation, and subsequent histopathology and complications associated with the morbidity and mortality of emergency appendectomy. The clinical diagnosis was correct in 278 patients (88%). Thirty-nine (12%) of the patients had a negative laparotomy. There was no mortality, and wound infection was the source of increased morbidity in 37 (12%) patients. The highest incidence of wound infection was among those who had pus in the peritoneum (20%) or had a perforated or gangrenous appendix (25%). When the macroscopic appearance of the appendix was compared with the subsequent histopathological findings, a false positive error of 7% and a false negative error of 42% was found. During appendectomy the gross appearance of the appendix must be carefully noted so that a meticulous surgical technique can be complemented by appropriate antibiotic prophylaxis against wound infection, started at the time of surgery.

Topical ampicillin for prophylaxis against wound infection in acute appendicitis.

A total of 249 patients, undergoing appendectomy for acute appendicitis, were prospectively randomized into two groups. Group I, comprising 132 patients, received sterile normal saline irrigation to the surgical wound at closure. Alternatively, Group II included 117 patients, who received intraoperative topical ampicillin irrigation of the wound. Both groups were comparable with regard to age, sex, duration of symptoms, and severity of appendicitis. All patients additionally received preoperative systemic gentamicin and Flagyl. Wound infection occurred in 5.3% of Group I compared to only 0.9% of Group II (P<0.05). The reduction in infection rate was significant (P<0.05) in histologically proven appendicitis. We conclude that the addition of intraoperative topical ampicillin to systemic gentamicin and Flagyl augments prophylaxis against wound infection in acute appendicitis.

Gastric torsion: Not such a rare entity.

We describe seven patients who suffered chronic gastric torsion, seen during a 28-month period. Four were children, of which three were infants. The infants had projectile vomiting and two also had failure to thrive. The adults presented with epigastric pain and vomiting. Upper gastrointestinal series clinched the diagnosis in all patients. The classic radiographic presentation of a stomach lying across the epigastrium with the cardia and fundus in a dependent position to the body of the stomach and pylorus may be overlooked in some cases. Choice of surgical procedure in its management has been discussed. There was no associated abnormality in four of the six operated cases. One infant had an atretic bowel, vascular anomalies, umbilical hernia, and previous meconium peritonitis; a second infant had jejunojejunal intussusception. A high index of suspicion is warranted in patients presenting with recurrent abdominal pain or in infants with unexplained vomiting and failure to thrive. Upper gastrointestinal series in adults should preferably be performed while the pain is present.