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issn:2229-340
1.  An unusual case of chronic prostatitis caused by Haemophilus influenzae in an elderly Saudi patient: A case report and literature review 
Haemophilus influenzae has been reported on rare occasions as the cause of prostatitis and urinary tract infections. Here, we report a rare case of chronic prostatitis in a 52-year-old male with benign prostatic hypertrophy and discuss the possible underestimation of the true incidence of H. influenzae in genitourinary infections. This organism was identified only by its growth on chocolate agar, a medium that is not commonly used for urine cultures.
doi:10.4103/2230-8229.142975
PMCID: PMC4214010  PMID: 25374472
Chronic prostatitis; elderly; Haemophilus influenzae
2.  Henoch–Schonlein purpura presenting sequentially as nodular rash, erythema nodosum, and palpable purpura 
We describe a 26-year-old woman who presented with a nodular rash on the elbows following an insect bite. Two days later, she developed erythema nodosum. Both these lesions were treated symptomatically. One week later, she had purpura, abdominal pain, hematuria, and arthralgias, following which steroids were administered. Her investigations revealed only microscopic hematuria that disappeared with therapy. This pattern of sequential appearance of rash and a nodular morphology are both unique features not previously reported.
doi:10.4103/2230-8229.128788
PMCID: PMC3966098  PMID: 24696039
Adult; erythema nodosum; Henoch–Schonlein purpura; nodular rash
3.  Symptomatic cycling Cushing disease managed by simultaneous bilateral laparoscopic adrenalectomy in a 11-year-old boy 
We report symptomatic cycling Cushing disease in a 11-year-old boy that was managed with simultaneous bilateral laparoscopic adrenalectomy. Positioning and the surgical technique have been fully described. Excellent results were achieved. Recent application of laparoscopic adrenalectomy for various adrenal pathology is highly effective and offers better results than open surgery. Post-operative recovery after laparoscopic technique is significantly shorter than the open technique.
doi:10.4103/2230-8229.128791
PMCID: PMC3966100  PMID: 24696635
Cycling Cushing disease; laparoscopic adrenalectomy; laparoscopic adrenalectomy in children; simultaneous bilateral adrenalectomy
4.  Paraquat poisoning: A case report and review of literature 
Paraquat (1, r-dimethyl-4,4’-bipyridium dichloride), a brown syrupy liquid is an effective herbicide that has low chronic toxicity because of its rapid deactivation on contact with soil. A high dose of paraquat or severe poisoning has a poor prognosis. At present there is no specific antidote to paraquat poisoning, hence the need to focus on prevention and in case of exposure or ingestion, aggressive decontamination to prevent further absorption. Although uncommon, paraquat ingestion can lead to severe and often fatal toxicity. However, despite its widespread availability, reports of this herbicide poisoning in India are uncommon.
doi:10.4103/2230-8229.122023
PMCID: PMC3957175  PMID: 24672279
Mortality; outcome; paraquat positioning
5.  Mycetoma foot 
Mycetoma is an uncommon chronic granulomatous infective disease of the skin, dermis and subcutaneous tissues predominantly seen in tropical countries. A patient presented to our hospital with the swelling of the left foot with a healed sinus and a painful nodule. He gave a history of sinuses in the left foot from which there was discharge of yellow granules. Culture of the ultrasound guided fine needle aspiration cytology of the nodule revealed growths of Nocardia species. The patient was treated with a multi-drug therapy along with debridement of the painful nodule. He experienced symptomatic relief and a regression of the swelling within the three months of follow-up so far. Due to the relatively slow progression of the disease, patients are diagnosed at a late stage. Hence, emphasis should be placed on health education and the importance of wearing footwear.
doi:10.4103/2230-8229.114775
PMCID: PMC3748649  PMID: 23983567
Actinomycetoma; grains; Madura foot
6.  Hyercalcemia induced by interferon therapy in chronic hepatitis C 
Interferon is being increasingly used in the treatment of chronic hepatitis C. Several case reports have suggested an association between interferon therapy and sarcoidosis with hypercalcemia. We report a case of severe hypercalcemic crisis with bilateral hilar lymphadenopathy in a male patient who was receiving interferon therapy for hepatitis C. Gastroenterologists should be aware of this unusual but clinically important complication of interferon therapy.
doi:10.4103/2230-8229.98308
PMCID: PMC3410179  PMID: 22870420
Hypercalcemia; interferon; sarcoidosis
7.  A study on rapid confirmation of pulmonary tuberculosis in smear-negative acid fast bacilli cases by using fiberoptic bronchoscopy, done through a trans oro pharyngeal spacer 
Introduction:
The tuberculosis control program is based on a felt need–oriented basis. The diagnosis is mainly microbiological. However, sputum smear-negative Acid Fast Bacilli (AFB) cases with suspected radiological findings can be problematic in diagnosis.
Objectives:
To confirm the diagnosis of tuberculosis early, in smear-negative AFB cases by using a Fiberoptic Bronchoscope.
Materials and Methods:
We embarked on Fiberoptic Bronchoscopy (FOB) and Spot Scopy smear Microscopy (SSM) for 533 suspected Pulmonary Tuberculosis (PT) cases (sputum smear negative and radiologically suggestive) from February 2007 to May 2010. FOB was performed using a special device, a Trans Oro Pharyngeal Spacer (TOPS), as a conduit.
Results:
The yield for positivity for AFB was 341 (64%) out of 533 cases.
Conclusion and Recommendation:
The specimens collected by using the fiberoptic bronchoscope confirmed the disease in the smear-negative cases. Hence, FOB was recommended in smear-negative cases, to avoid delay in the treatment of tuberculosis.
doi:10.4103/2230-8229.94014
PMCID: PMC3326770  PMID: 22518358
Fiberoptic bronchoscopy; pulmonary tuberculosis; spot scopy smear microscopy; trans oro pharyngeal spacer
8.  Recurrent hydatidiform mole: A case report of six consecutive molar pregnancies complicated by choriocarcinoma, and review of the literature 
Hydatidiform mole (HM) is the most common form of gestational trophoblastic neoplasia. Recurrence of HM is extremely rare. Here, we report the case of a patient with six consecutive partial HMs without normal pregnancy. A 42-year-old lady who was referred to us at King Fahad Hospital of the University, Al Khobar, initially as a case of 26-year-old with persistent trophoblastic disease after three recurrent molar pregnancies that were confirmed histologically in the referring hospital. She underwent evacuation and curettage and was followed up by serial β-human chorionic gonadotropin levels, and did not require chemotherapy. She then had three more molar pregnancies in 1995, 1996, and 2004; all molar pregnancies were evacuated by suction curettage at her base hospital, but in the last event, she complained of shortness of breath and abdominal pain. Diagnostic workup in our hospital confirmed choriocarcinoma, for which she received multiple regimen chemotherapy and was cured. Unfortunately, she lately presented with symptoms suggestive of premature menopause.
doi:10.4103/2230-8229.90018
PMCID: PMC3237206  PMID: 22175045
Choriocarcinoma; hydatidiform mole; recurrent mole
9.  Peripheral polyneuropathy after bariatric surgery for morbid obesity 
A patient with peripheral polyneuropathy after bariatric surgery for morbid obesity is reported. She suffered from frequent episodes of vomiting and abdominal pain after surgery. Muscle weakness in her lower limbs developed 5 months later and she experienced difficulty in walking and standing. Wrist drop, foot drop, and marked distal limb muscle atrophy were found bilaterally. Electromyography showed the presence of sensorimotor axonal polyneuropathy. Nutritional deficiencies may play an important role in pathogenesis. This uncommon neurological complication might be due to rapid weight loss and vitamin deficiency. Physicians who take care for patients after bariatric surgery should have a high index of awareness for the neurologic complications, and routine vitamin supplementation might be useful for these patients.
doi:10.4103/2230-8229.90020
PMCID: PMC3237207  PMID: 22175046
Bariatric surgery; morbid obesity; polyneuropathy
10.  An unusual complication of unsafe abortion 
Unsafe abortion is a significant medical and social problem worldwide. In developing countries, most of the unsafe abortions are performed by untrained personnel leading to high mortality and morbidity
Case Report:
A 30 year-old female, gravida 7, para 6 underwent uterine evacuation for heavy bleeding per vaginum following intake of abortifacient to abort a 14 weeks gestation. The procedure was performed at a rural setup and her bowel was pulled out of the introitus through the perforated wound, an unusual complication of unsafe abortion. Illiteracy, unawareness about health services, and easy accessibility to untrained abortion providers lead to very high mortality and morbidity in India. There is unmet need to bring awareness among the people about the safe and effective methods of contraception and abortion services to avoid such complications.
doi:10.4103/2230-8229.90021
PMCID: PMC3237208  PMID: 22175047
Unsafe abortion; uterine evacuation; uterine perforation
11.  Breast abscess caused by penicillin resistant Pneumococci 
Breast abscess is mostly caused by Staphylococcus aureus. A 26-year-old immunocompetent lady was admitted with breast abscess. Incision and drainage (I/D) was done and Pneumococci were isolated from the drained pus. The patient was earlier treated with Augmentin which was later changed to linezolid after testing for antibiotic susceptibility. This strain showed a high level of resistance to penicillin. It had been noticed that there was a slow increase in the number of penicillin resistant Pneumococci isolated in our hospitals. The increase in penicillin-resistant Pneumococci correlates with the intensive use of beta-lactam antibiotics. Hence, antibiotics should be used judiciously, avoiding their use particularly in mild self-limiting upper respiratory infections. Attention therefore, should focus on monitoring resistance in Pneumococci to prevent mortality and morbidity associated with this organism, which continues to take a heavy toll on children and the elderly.
doi:10.4103/2230-8229.83375
PMCID: PMC3159234  PMID: 21897917
Breast abscess; penicillin resistant Pneumococci
12.  A forgotten complication of diaper dermatitis: Granuloma gluteale infantum 
Granuloma Gluteale Infantum (GGI) is a rare condition of unclear etiology,[1] presenting as asymptomatic cherry red nodules in the diaper area appearing in the setting of primary irritant contact dermatitis.[2] A 50 day old infant with GGI is presented to emphasize that the condition may be easily missed, and that it may result from the misuse of fluorinated topical steroids used to treat a rash in the diaper area. This is the first case reported from Saudi Arabia.
doi:10.4103/1319-1683.71994
PMCID: PMC3045094  PMID: 21359035
Granuloma gluteale infantum; fluorinated steroids; diaper dermatitis
13.  Psuedomyxoma peritonei secondary to adenocarcinoma of the cecum 
Pseudomyxoma peritonei is a rare progressive disease. Patients commonly present with a picture of acute appendicitis or with increasing abdominal girth. We present a case of a 71 year old man who presented with right iliac fossa pain, fever and vomiting. His abdominal examination revealed right iliac fossa mass which was confirmed radiologically. Diagnostic laparoscopy showed jelly like material along with a right iliac fossa mass. The aspirate was negative for malignancy initially. Due to persistance and progression of his disease he underwent right hemicolectomy. Histopathological diagnosis showed moderately differentiated adenocarcinoma of the cecum Duke’s C2.
doi:10.4103/1319-1683.71993
PMCID: PMC3045095  PMID: 21359034
Pseuomyxoma peritonei; mucinous adenocarcinoma
14.  THE SELF-LIMITING NATURE OF STATIN-INDUCED RHABDOMYOLYSIS 
Statins have come to the forefront of treatments for hyperlipidemias, coronary artery diseases and strokes. They have been shown to cause myotoxicity and rhabdomyolysis. In most cases, rhabdomyolysis is self-limiting and needs supportive therapy. Two cases of statin-induced rhabdomyolysis are reported emphasizing the definition, risk factors, clinical features and the self-limiting nature of the disorder.
PMCID: PMC3377045  PMID: 23012203
Statins; myopathy; rhabdomyolysis
15.  ACUTE PLASMODIUM VIVAX MALARIA PRESENTING WITH PANCYTOPENIA SECONDARY TO HEMOPHAGOCYTIC SYNDROME: CASE REPORT AND LITERATURE REVIEW 
Pancytopenia as an initial manifestation of acute plasmodium vivax malaria is extremely rare and mainly reported with plasmodium falciparum. We report a 37- year old Nepali patient who recently came to Saudi Arabia and presented with a three-week history of intermittent fever, chills and rigor. She was found to have spleenomegaly, pancytopenia, hyperferrtinemia, and hypofibronogenemia with positive peripheral blood smear for plasmodium vivax. The patient had a full recovery from pancytopenia with oral chloroquine.
PMCID: PMC3377033  PMID: 23012194
Pancytopenia; plasmodium vivax; hemophagocytosis; malaria; bone marrow failure
16.  A RIGHT CORONARY ARTERY ANEURYSM ASSOCIATED WITH CHEST PAIN: A CASE REPORT 
A 46-year-old female is the first to be described from Saudi Arabia with a right coronary artery aneurysm associated with chest pain. A review of the coronary aneurysm is discussed with its implications on our patient.
PMCID: PMC3377034  PMID: 23012195
Saudi Arabia; aneurysm; coronary; chest pain
17.  SONOGRAPHIC DIAGNOSIS OF GASTRIC-OUTLET FOREIGN BODY: CASE REPORT AND REVIEW OF LITERATURE 
The diagnosis of unsuspected foreign body ingestion is a common problem in children. We describe a toddler who presented with persistent vomiting and dehydration. A plain radiograph of the abdomen did not reveal a foreign body. However, abdominal ultrasonography promptly identified a funnel-shaped foreign body obstructing the gastric outlet. This was extracted by upper endoscopy. A recent review of the literature shows increasing evidence that abdominal ultrasonography is an equally complementary diagnostic modality for ingested foreign bodies in children.
PMCID: PMC3377018  PMID: 23012187
Gastrointestinal foreign body; Sonographic diagnosis; Gastric outlet obstruction; Abdominal ultrasonography
18.  ALLGROVE'S SYNDROME: CASE REPORT AND LITERATURE REVIEW 
This report concerns two brothers aged 10 and 18 years with long-standing dysphagia that started at age three and six years respectively. They had been diagnosed as achalasia and treated accordingly. The appearance of additional symptoms and clinical signs required further investigations including abdominal sonography, esophago-gastroduodenoscopy, barium swallow, esophageal manometry, computerized tomography (CT) of abdomen and brain, biochemical profiles, and neurologic and ophthalmic evaluations. The results of these extensive investigations along with the clinical evaluations were consistent with Allgrove's syndrome.
Glucocorticoid therapy was initiated. The management consisted of pneumatic cardiac dilatation and initiation of cortisone treatment. The patients’ response was impressive and they resumed most of their usual activities.
PMCID: PMC3377019  PMID: 23012188
Allgrove's syndrome; Triple A syndrome; Achalasia; Alacrima; Autonomic neuropathy; Adrenocortical impairment; Pneumatic dilatation; Steroid therapy
19.  BREAST CANCER MANAGEMENT DELAY - TIME FOR IMPROVEMENT: A REFLECTION FROM THE EASTERN PROVINCE OF SAUDI ARABIA 
Objective:
Breast cancer is the commonest international malignancy among women. Its increased prevalence over recent years in our part of the world has prompted women to randomly seek medical advice. Many patients are delayed for weeks to months prior to receiving medical treatment. This review explores the causes of delay and proposes possible solutions.
Materials and Methods:
This review was undertaken at King Fahd Hospital of the University, a tertiary care center with the capacity of 420 beds. It accommodates a large number of referrals from the Eastern Province, other regions of the Kingdom, in addition to many walk-in patients. Most of the patients referred with breast cancer are directed to the breast clinic for treatment. There was random re-tracing of patients’ steps from the discovery of the suspicious breast mass to the delivery of care.
Results:
The total number of diagnosed breast cancer cases at this center between 1997-2007 was 303, with a total number of 975 registered visits. Random retracing of these patients’ records identified three points of delay: community related, primary heath care and tertiary care. It was found that the patients spent 6-15 weeks and around 32-38 hand offs before receiving the final care.
Conclusion:
This unnecessary delay creates anxiety and mistrust of the operating health system leading patients to seek alternative medicine or treatment abroad.
A multidisciplinary one-stop breast oncology clinic may be the solution to the above problem. It may allow the fast tracking of breast cancer patients through a highly specialized and welltrained multidisciplinary team that offers the highest quality of care, thereby optimizing the chances of cure with the least delay and possible morbidity.
PMCID: PMC3377124  PMID: 23012177
Breast cancer; management; delay
20.  PRIMARY SYNOVIAL SARCOMA OF THE ABDOMINAL WALL: A CASE REPORT AND REVIEW OF THE LITERATURE 
Synovial sarcoma is a malignant mesenchymal neoplasm which commonly occurs in the extremities of adults, in close association with joint capsules, tendon sheaths, bursae and fascial structures. Only a few cases of synovial sarcoma occurring in the abdominal wall have been reported. A case of a primary synovial sarcoma arising from the anterior abdominal wall fascial aponeurosis is presented.
PMCID: PMC3377125  PMID: 23012178
Synovial sarcoma; abdominal wall tumor
21.  OVARIAN DYSGERMINOMA IN TWO SISTERS 
Although rare, dysgerminomas are important irrespective of incidence because they affect women of reproductive age (i.e., <45 years). Dysgerminomas make up two thirds of all malignant ovarian neoplasms in women younger than 20 years. All dysgerminomas are considered malignant, but only one third of dysgerminomas behave aggressively. Their exact etiology has not been determined. Few reports are found in the review of the literature on the incidence of dysgerminoma and other germ cell tumors in families. Some of these reports focus on the genetic abnormalities associated with germ cell tumor and the responsible gene. Two cases of dysgerminomas diagnosed in two sisters aged 14 and 19 years old are presented here with their radiological studies.
PMCID: PMC3377126  PMID: 23012179
Dysgerminoma; Germ Cell Tumor; Familial incidence; Imaging
22.  CONGENITAL MESOBLASTIC NEPHROMA: A CASE REPORT 
Congenital mesoblastic nephroma (CMN) is a rare renal tumor. It can be detected antenatally especially with judicious use of ultrasonography.
A premature female neonate 28 weeks’ gestation, complicated by polyhydramnios, was born to a 28-year-old woman. An abdominal mass was detected antenatally. At the end of the first week of life, the newborn had hypertension that was controlled by hydralazine. Ultrasonography and CT scan showed a right-sided renal heterogeneous solid mass. Right nephrectomy was performed and the histology showed CMN.
PMCID: PMC3377027  PMID: 23012173
Congenital mesoblastic nephroma; Polyhydramnios; Neonatal hypertension
23.  THYROID STORM PRESENTING AS ACUTE ABDOMEN AND NORMOTHERMIA 
Thyroid storm is a known complication of thyroid surgery. Nowadays, it is commonly seen in thyrotoxic patients. In this case report we discuss a patient who presented with acute abdomen and normothermia and was discovered to have thyrotoxicosis, a rare feature of thyroid storm.
PMCID: PMC3410081  PMID: 23012061
Thyroid storm; acute abdomen
24.  ACUTE ABDOMEN WITH PNEUMOPERITONEUM 
Acute appendicitis is a common cause of acute abdomen. However, it is a rare cause of pneumoperitonium. In this report the surgical diagnoses and management will be discussed in detail.
PMCID: PMC3410093  PMID: 23012052
Acute abdomen; peritoneum
25.  HYPOTHYROIDISM PRESENTING WITH DYSARTHRIA 
Hypothyroidism is a common endocrine disorder with characteristic clinical symptoms and signs. Typical symptoms of hypothyroidism are lethargy, cold intolerance, slowing of intellectual and motor activity, decreased appetite, weight gain, and dry skin. A 39-year-old female presented to the clinic with dysarthria as the chief symptom. Subsequent questions revealed that other symptoms were confined to the otolaryngeal region, which were episodes of mild dysphonia, dysphagia, sleep apnea, and snoring. Laboratory data revealed marked hypothyroidism and positive tests for antithyroglobulin and antimicrosomal antibodies. After administration of thyroxin, the dysarthria and the other symptoms rapidly disappeared. Dysarthria may be the presenting symptom of hypothyroidism and can be resolved after hormone replacement therapy.
PMCID: PMC3425768  PMID: 23011993
Dysarthria Hypothyroidism

Results 1-25 (29)