Primary hyperparathyroidism in Saudi Arabia: a review of 46 cases

Records of 46 patients who were treated for primary hyperparathyroidism at King Khalid University Hospital, Riyadh Saudi Arabia from 1st July 2000 to 30th June 2006 were reviewed. Mean age at diagnosis was 44 years (range 13-70 years) and average duration of symptoms was 39 months (1 month to 11 years). There were 35 females and 11 males with a ratio of 3.2:1. Bone pains were the major symptoms at presentation in 45.7% followed by no symptom in 23.9%, renal stones in 15.2%, polyuria in 6.5%, while 4.3% each presented with depression, and constipation. Males had significantly more severe disease with higher serum calcium, higher urinary calcium excretion, and higher serum creatinine. Ninety six percent of patients had successful surgery and 4% (two patients) each had recurrence and hungry bone syndrome. It is concluded that PHPT in Saudi Arabia continues to be a symptomatic disorder with skeletal and renal manifestations occurring at a younger age and males having more severe disease. Further prospective studies are needed to verify our findings.     

Primary ovarian hydatid disease in the Kingdom of Saudi Arabia

Human hydatid disease is caused by Echinococcus granulosus. Its distribution is world wide and it affects mainly the liver, but other organs could be involved. Primary involvement of pelvic organs is very rare. This is a case report of primary ovarian hydatid disease in a postmenopausal woman, diagnosed postoperatively. Surgical excision was adequate. Ultrasonography, particularly high frequency trans-vaginal, computed tomography scan and, more recently, magnetic resonance imaging are more frequently used in the diagnosis of Echinococcus cyst. They appear more reliable than many of the old tests of varying sensitivities. Whereas, there are anecdotal reports of obstetric and gynecological manifestations of echinococcosis from some Middle Eastern and North African countries, this is the first of such report from the Kingdom of Saudi Arabia. It is unclear why there is a lack of information about this condition among Saudi women, even though socio-cultural attitude to female involvement in sheep farming and animal husbandry is similar to that in other Arabic and Islamic countries. We endorse the recommendation that every gynecologist, radiologist and histopathologist should maintain a high index of suspicion for hydatid cyst, whenever a septate cystic pelvic mass is found.     

Profile of benign breast diseases in western Saudi Arabia: An 8-year histopathological review of 603 cases

Objectives:

To describe the histopathological patterns of benign breast diseases (BBD) among Saudi patients.

Methods:

This is a retrospective review of BBD reports of Saudi patients of both genders and all age groups seen between January 2006 and December 2013 at King Fahad Hospital, Madinah, Kingdom of Saudi Arabia.

Results:

Out of the total 1005 breast biopsies, 603 cases (60%) were BBD. The female to male ratio was 30.7:1. The overall mean age for BBD was 27.5 years, with an age range of 14-80 years. The most common lesion was fibroadenoma (FA) accounting for 44.3% of cases (mean age: 23.5 years), followed by 23.4% fibrocystic change (FCC) (mean age: 37.1 years). Both lesions had a peak occurrence in the third decade. Inflammatory lesions constituted 13.9% of cases. Most common were granulomatous mastitis (3.5%), chronic mastitis (3.3%), and acute mastitis with abscess (3.1%). Other major lesions encountered were fibroadenomatoid hyperplasia (3.1%), intraductal papilloma (2.8%), and benign phylloides tumor (2.6%). All benign diagnoses in male patients were gynecomastia and most patients (68.4%) were under 40 years.

Conclusion:

In this study, BBD constituted 60% of breast lumps, and were mostly FA and FCC. The BBD peaked at the 20-29 year age range.Breast diseases are a significant component of the routine workload and experience of a histopathologist, due to the increasing awareness regarding breast cancer (BC). Breast cancer is the most common cancer among women with an estimated 1.67 million new cancer cases diagnosed in 2012 as reported by GLOBOCAN,1 as well as in the Kingdom of Saudi Arabia (KSA), according to the 2012 Saudi Tumor Registry report.2 Reviewing the recent medical literature of the last decade on BBD,3-6 a number of articles reporting the spectrum of BBD on hospital-based retrospective studies in the histopathology laboratories were found. However, there is only one BBD publication from KSA during the last decade, which is from the Eastern region of KSA. There is a lack of publications on BBD from the Western region recently. Therefore, our study was carried out to observe any changes in the disease patterns of BC. The aim of the present study has been describe the histopathological patterns of BBD among Saudi patients in Madinah, KSA.     

Allergic fungal rhinosinusitis: report of 4 cases from Saudi Arabia

Allergic fungal rhinosinusitis is a newly recognized clinical entity of chronic rhinosinusitis. Over the past 3 years, 4 such patients were treated in our hospital. The clinical and pathological features of these 4 cases which merited the criteria for such diagnosis, are described. All the 4 cases had history of nasal polyps, asthma, or both with radiographical evidence of pansinusitis. Histologically, the thick greenish-brown inspissated material specimens which were collected and submitted to the laboratory showed, eosinophils, Charcot-Leyden crystals but no fungal elements were detected on routine hematoxylin and eosin sections and no tissue invasion was noted. However, scanty aspergillus hyphae were detected on sections stained with silver. All 4 cases grew Aspergillus flavus only from the swabs and no other fungi were seen and all were treated by surgical debridement, aeration, oral itraconazole with no steroids.     

Insulinoma in Saudi Arabia: a twenty-year hospital study

The study was designed to assess retrospectively clinical pattern of insulinoma at a national referral center in the Kingdom of Saudi Arabia. All cases of insulinoma recorded at King Khalid University Hospital Riyadh between January 1987 and December 2006 were reviewed. During the 20-year period five patients were seen comprising three females (ages 38, 40, and 70 years) and two males (17 and 34 years). The duration of symptoms prior to diagnosis ranged between one and eight years. The commonest mode of presentation before diagnosis was inability to observe Ramadan fasting. Other notable symptoms included dizziness and loss of consciousness. All the five patients proceeded to operation. At surgery all were found to be benign tumors. Post-operatively, three of the patients developed pseudocyst, which resolved upon undergoing second surgery. Though clinical presentation of insulinoma in Saudi subjects is similar to those reported in the literature, our study revealed prominent symptoms occurring during yearly ramadan religious fast could be a useful information in history taking. Further studies on a larger population are needed to further characterize our findings.     

Insulinoma in Saudi Arabia: a twenty-year hospital study

The study was designed to assess retrospectively clinical pattern of insulinoma at a national referral center in the Kingdom of Saudi Arabia. All cases of insulinoma recorded at King Khalid University Hospital Riyadh between January 1987 and December 2006 were reviewed. During the 20-year period five patients were seen comprising three females (ages 38, 40, and 70 years) and two males (17 and 34 years). The duration of symptoms prior to diagnosis ranged between one and eight years. The commonest mode of presentation before diagnosis was inability to observe Ramadan fasting. Other notable symptoms included dizziness and loss of consciousness. All the five patients proceeded to operation. At surgery all were found to be benign tumors. Post-operatively, three of the patients developed pseudocyst, which resolved upon undergoing second surgery. Though clinical presentation of insulinoma in Saudi subjects is similar to those reported in the literature, our study revealed prominent symptoms occurring during yearly ramadan religious fast could be a useful information in history taking. Further studies on a larger population are needed to further characterize our findings.     

Blindness in Saudi Arabia

The prevalence and etiology of visual loss and of eye diseases were determined in the Kingdom of Saudi Arabia. The sample was a stratified geographic cluster sample of 14,577 persons representing the settled population of Saudi Arabia. A nonstatistical sample of 2,233 bedouins was also examined. The survey revealed that 1.5% of the population are blind and another 7.8% are visually impaired according to the World Health Organization definition. The most common causes of blindness include cataract, trachoma, nontrachomatous corneal scars, refractive errors, congenital anomalies, failed medical or surgical treatment, and glaucoma. Refractive errors, amblyopia, and trauma are also important causes of less severe, and often unilateral, lost vision. About 7% of all Saudi Arabians, and 42% of those older than 40 years, have a cataract or its sequelae. Over 3.5% of the population have corneal scars, about half of which are caused by trachoma.     

Diphyllobothriasis in Saudi Arabia

We described a Saudi patient infected with Diphyllobothrium latum D. latum. A 38-year-old male presented, complaining of passing worms. He had a history of recent travel to Europe and South East Asia. Stools examination revealed typical D. latum eggs. He was treated with praziquantel followed by saline purge, after which he discharged an intact tapeworm. Macroscopic and microscopic examinations of the worm confirmed the diagnosis of D. latum. This is the first case of diphyllobothriasis to be reported in Saudi Arabia. The epidemiology and methods of prevention of diphyllobothriasis are discussed.     

Hyperlipidemia in Saudi Arabia

OBJECTIVE: To determine the prevalence of hyperlipidemia among Saudis of both genders in rural and urban communities. METHODS: Selected Saudis in the age group of 30-70 years were studied over a 5-year period between 1995 and 2000 in Saudi Arabia. Data were obtained from history, physical examination, and analysis of fasting plasma lipids. The data were analyzed to classify individuals with hypercholesterolemia (HC) (total cholesterol > or =5.2 mmol/l), and hypertriglyceridemia (HT) (total triglycerides > or =1.69 mmol/l). Logistic regression analysis was performed to provide a risk assessment model and correlation with other coronary artery disease (CAD) risk factors. RESULTS: The number of study samples included in the final analysis was 16,819. The prevalence of HC was 54% with mean cholesterol level of 5.4+/-1.52 mmol/l. Prevalence of HC among males was 54.9% and 53.2% for females, while 53.4% among urban Saudis and 55.3% for rural Saudis. Hypertriglycemia prevalence was 40.3% with mean triglycerides level of 1.8+/-1.29 mmol/l. Males had statistically significant higher HT prevalence of 47.6% compared to 33.7% in females (p<0.0001). CONCLUSION: Hyperlipedimia is reaching higher prevalence rates in KSA. This finding may suggest that CAD will soon be a major health problem. Reduction in obesity by adopting healthier eating habits, and increasing physical activity are of considerable importance to our community.     

Leukaemia cases in Central Hospital, Riyadh (Saudi Arabia)

A total of 293 cases of various types of leukaemia admitted in Central Hospital (Riyadh) were studied from January 1981 to December 1988. The incidence of leukaemia was worked out to be 0.13% of the total hospital population during this period. Acute non-lymphocytic leukaemia (ANLL) or acute myeloid leukaemia (AML) group was the most frequent (37.54%), followed by acute lymphocytic leukaemia (24.23%) followed by chronic myeloid leukaemia [corrected] (19.11%), chronic lymphocytic leukaemia (CLL) group (18.77%) and lymphosarcoma cell leukaemia (LSCL) (0.35%). Acute leukaemias were further classified into subtypes on the basis of FAB (French-American-British) classification. In ANLL or AML group, the pattern was M2 greater than M4 greater than M3 greater than M6 greater than M1 greater than M5. In ALL group, the pattern was L2 greater than L1 greater than L3. Among FAB subtypes of acute leukaemias, the pattern was L2 greater than M2 greater than M4 greater than M3 greater than M6 greater than M1 and L1 greater than L3 greater than M5. The age range of these patients was 5 years to 80 years; only 9 cases were less than 11 years of age. In childhood and young adults, acute leukaemias (ALL and AML) were the commonest types (particularly ALL was common in childhood), whereas CML was common in adults and CLL in old age. Males dominated the females in all the types of leukaemia (male to female ratio was 2.4:1). Out of 293 leukaemia cases, 149 (51.0%) were Saudi Arabs, the rest were expatriates. AML was found to be the most common type in central, western and southern Saudi Arabia.(ABSTRACT TRUNCATED AT 250 WORDS)