Outcome of surgery for parotid tumours: 5-year experience of a general surgical unit in a teaching hospital

BACKGROUND: Most of the recent reports on the surgical management of parotid gland disorders come from specialist divisions of otolaryngology, head and neck, or faciomaxillary surgery. The aim of the present study was to evaluate the outcome of surgery for parotid tumours in a general surgical unit of a teaching hospital. METHOD: A prospective clinicopathological study was undertaken over a 5-year period for consecutive patients operated on for parotid gland tumours in the King Saud University Unit of Riyadh Medical Complex. Parameters analyzed were demographic details, clinical presentation, diagnostic work-up, type of surgery, and outcome in terms of early and late morbidity. RESULTS: Thirty seven parotid operations were performed on 36 consecutive patients. All patients presented with parotid gland swelling. Mean age was 51.6 years with a male preponderance. Fine-needle aspiration diagnosed the pathology in 33 out of 37 lesions. Pleomorphic adenoma was the commonest pathology observed in 24 patients (64.9%). Warthin's tumour was more common among male patients and was the only pathology with bilateral involvement. Malignant tumour was found in five patients (13.5%). Superficial conservative parotidectomy was the most frequently performed operation (84%). Overall postoperative morbidity was 13.5%. Transient facial nerve palsy was observed in seven cases (19%). There was no recurrence identified in patients with benign diseases during the mean follow up of 38.5 months. CONCLUSION: Parotid gland surgery can still be performed in a general surgery unit with comparable outcome. However, the operation should be performed in units with special interest and experience in surgery for parotid gland disorders.     

Hypersplenism in homozygous sickle-cell disease in Saudi Arabia

Black children with homozygous sickle-cell disease usually have anatomic asplenia by 6-8 years of age. In the Eastern Province of Saudi Arabia, sickle-cell disease runs a benign course. Here we report six sicklers with hypersplenism as manifested by 1: splenomegaly (6/6); 2: persistent thrombocytopenia (6/6); 3: increasing severity of anaemia with the need for repeated blood transfusion (5/6); 4: leukopenia (1/6); 5: high reticulocyte count (6/6); 6: circulating nucleated red blood cells (5/6). All improved after splenectomy, with resolution of the thrombocytopenia and leukopenia, improvement in the degree of anaemia, decrease in the reticulocytes and disappearance of circulating nucleated red blood cells.     

Immunophenotyping of peripheral blood lymphocytes in Saudi men

Flow cytometry is an important tool for the diagnosis and follow-up of immunodeficiency patients, as well as for patients with leukemia and lymphoma. Lymphocytes and their subsets show variations with race. The aim of this study was to establish reference ranges for lymphocytes and their subsets in an Saudi adult population by using flow cytometry. Blood samples obtained from 209 healthy Saudi men were used for this study. All blood donors were between 18 and 44 years old. Lymphocytes and their subsets were analyzed by flow cytometry, and the absolute and percentage values were calculated. We investigated the expression of T-cell markers (CD3, CD4, and CD8), B cells (CD19), and natural killer cells (CD16 and CD56). The absolute and percent values of each cell subset were compared with published data from different populations by using the Student t test. Reference ranges, each expressed as the mean +/- the standard deviation, were as follows: leukocytes (6,335 +/- 1759), total lymphocytes (2,224 +/- 717), CD3 cells (1,618 +/- 547), CD4 cells (869 +/- 310), CD8 cells (615 +/- 278), CD19 cells (230 +/- 130), and CD3-CD16(+)/CD56+ cells (262 +/- 178). The CD4/CD8 ratio was 1.6 +/- 0.7. Our results for B cells, CD4 cells, and CD8 cells and for the CD4/CD8 ratio fell in between the reported results for Ethiopian and Dutch subjects. Our results were also different from previously reported findings in an Saudi adult population that showed no increase in CD8 T cells. We thus establish here the reference ranges for lymphocytes and their subsets in a large cohort of Saudi men. The CD8 cell count was not abnormally high, as previously reported, and fell in between previous results obtained for African and European populations.     

Angioimmunoblastic lymphadenopathy (AIBL): a case report from Saudi Arabia

Angio immunoblastic lymphadenopathy (AIBL) is a recently described disease. It occurs most commonly in elderly patients with an average age of about 60 years. In children, few cases have been reported so far in the English literature (three occurred after thymic transplant and one case after infectious mononucleosis). AIBL has characteristics manifested by clinical, pathological and laboratory findings. Steroids, alone or with chemotherapy, are used for treatment with variable results. Herein, we report one child with AIBL who was treated with prednisone initially and then relapsed. Chemotherapy (cyclophosphamide, vincristine and prednisone) was added and she has been in remission for more than 3 years. The purpose of this report is to add AIBL to the differential diagnosis of acute generalized lymphadenopathy in children.     

Use of the dry angle isolation adjunct in general dentistry: a clinical approach

The dry angle is a thin, triangle-shaped piece of moisture-absorbing cellulose that is placed over the buccal mucosa. It absorbs parotid gland saliva and some mandibular saliva, and helps to maintain a dry working field. It is an adjunct to rubber dam isolation and can facilitate dry field isolation in ways that cotton rolls cannot. Its thinness allows it to be placed in the thin space between the maxillary second molars and the ramus aspect of the mandible and sometimes it may be the most practical tool for isolating second molars for bonding or cementation procedures. When slightly moistened with parotid saliva, the dry angle adheres to the surface of the buccal mucosa. It replaces the flabby surface of the buccal mucosa with the stif surface of the dry angle. This prevents suctioning of the mucosa by the high volume evacuator (HVE) suction tip, aids in retraction of the mucosa and increases the number of ways that instruments can be positioned intraorally without obstruction from the HVE suction tube. This article explains the clinical techniques and use of the dry angle in general dentistry.     

Molecular xenomonitoring (MX) and transmission assessment survey (TAS) of lymphatic filariasis elimination in two villages,Menoufyia Governorate,Egypt

Lymphatic filariasis (LF) is focally endemic in Egypt where the female mosquito, Culex pipiens, is responsible for its transmission. The aim of the study was to investigate the impact of implementation of the 13th round of MDA in two Egyptian villages in the Menoufyia Governorate area after failing the transmission assessment survey (TAS) in 2005 using two methods, and to decide whether it is safe to stop MDA in these, as well as in similar implementation units (IUs). To achieve this aim, both the immunochromatographic card test (ICT) and molecular xenomonitoring (MX) techniques were employed. A cross-sectional study was carried out in the villages in 2014 with two sections:

• Section (1): a school-based survey where all the primary school entrants (6–7) years of age were tested by ICT.
• Section (2): a mosquito-based survey where a total of 152 mosquito pools collected from Samalay and 167 from Kafr El-Tarainah were tested for the presence of the gDNA of Wuchereria bancrofti microfilaria by real-time PCR assays.

The results revealed that all primary school children in both villages were 100% negative for antigenemia. Also, all mosquito pools were 100% negative for the microfilarial gDNA.

     

FoxP3 demethylation is increased in human colorectal cancer and rat cholangiocarcinoma tissue

Objectives

FoxP3 expression is a marker for Tregs which are known to be involved in tumor immunity. We aimed to evaluate FoxP3 promoter demethylation in human colorectal cancer (CRC) and rat intrahepatic cholangiocarcinoma (ICC).

Design and methods

Bisulfite-treated genomic DNA templates of shock frozen paired samples were studied from 13 anonymous CRC patients and from 10 male rats (n = 6 ICC induced by thioacetamide and n = 4 age-matched controls). Real-time PCR was carried out using a LightCycler 480 system. Human FoxP3 and CD3 promoter demethylations were estimated using previously described assays; and rat FoxP3 promoter demethylation using a newly developed assay.

Results

A significant 3.5-fold increase of the demethylation in FoxP3 promoter region was found in human CRC and rat ICC (P < 0.05). The average frequency of cells with FoxP3 demethylation in patients suffering from CRC was 0.26% in normal tissue and 0.92% in tumor tissue (n = 11 paired samples). Although, no significant difference was found between the mean frequency of CD3 demethylation in normal tissue (4.80%, n = 6) and in tumor tissue (4.14%, n = 6) from CRC patients, the ratio of demethylated CD3/FoxP3 promoter areas was significantly lower in tumor specimens (P < 0.05). Using our novel assay, we found a significant increase in mean frequencies of cells with FoxP3 demethylation in rats with ICC (7.42%, n = 6) in comparison to controls (2.14%, n = 4).

Conclusion

FoxP3 seems to be an interesting biomarker for immune response to epithelial tumors. Functional consequences from the increase of Tregs remain to be demonstrated. Further studies with outcome data are necessary.     

A pragmatic evaluation of sleep patterns before gynecologic surgery

The aim of this study was to evaluate preoperative sleep patterns in-patients scheduled for elective endoscopic surgery and to compare sleep characteristics before different types of endoscopic procedures. A prospective survey cohort study (Canadian Task Force classification II-2) was designed to evaluate quantitative and qualitative (score 1–7) sleep parameters. Patients completed sleep-monitoring forms on the baseline (6 weeks before surgery), two nights (night-2), and the night before surgery (night-1). Of a total 119 women, 73 (61%) underwent laparoscopies and 46 (39%) hysteroscopies. Forty-seven (40%) operations involved organ removal and 72 (60%) were reconstructive surgery. The mean overall sleep-quality score on night-1 (3.29 ± 0.15) was higher (worse) than on baseline (2.09 ± 0.10, P < 0.0001) and night-2 (2.45 ± 0.11, P < 0.001, respectively). Patients reported more difficulty falling asleep on night-1 (2.53 ± 0.15) than on baseline (1.61 ± 0.09, P < 0.0001) and night-2 (1.84 ± 0.12, P = 0.001, respectively). The mean number of nocturnal awaking events was also highest on night-1 (1.52 ± 0.17) than on baseline (0.69 ± 0.09, P < 0.001) and night-2 (0.87 ± 0.09, P < 0.05 respectively). Using logistic regression, we found that age, stress level, and time before surgery (baseline, night-2, night-1), were significant predictors of poor sleep. The type of planned surgery did not influence the quality of sleep. Falling asleep on night-1 took longer than on baseline and night-2. There was no difference in the sleep quality measures between the baseline and night-2. Poor sleep quality is common mainly in the night before surgery. The nature and extent of planned surgery do not affect sleep quality variables.     

Acute splenic sequestration crises in Saudi children with sickle cell disease

Sickle cell disease (SCD) is a common disease in the Eastern Province of Saudi Arabia. Twenty per cent of the population have sickle cell trait and 1.75% have SCD. In the first 2 years of life, infection, hand-foot syndrome and acute splenic sequestration crisis (ASSC) are the most common complications of this disease. The classical characteristics of an ASSC, the subject of this paper, are sudden and rapid enlargement of the spleen, secondary to the massive pooling of red blood cells in the splenic sinusoids in a functioning spleen. Less common minor attacks of ASSC have been described recently. An ASSC is one of the most common causes of death in infants with SCD. The underlying cause and the precipitants of attacks of ASSC remain unknown. Seventeen children with ASSC were seen. Clinically, they had minor ASSC; three developed hypersplenism and four underwent splenectomy for recurrent attacks of ASSC. None of these 17 children had the classical ASSC described in black children where peripheral circulatory shock is encountered.