Intramedullary tuberculoma of the thoracic spine presented as paraparesis: A rare case report

Tuberculosis (TB) is a bacterial infection with Mycobacterium tuberculosis which primarily affects the lungs; however, it can affect any organ in the body. Brain tuberculous infection usually comes via hematogenous spread from a pulmonary focus and rarely via direct spread from ear, cranial vault or spine. It can present in various conditions including the following: tuberculous meningitis (TBM), brain or spinal cord tuberculoma, miliary TB, tuberculous abscess, tuberculous encephalopathy, and even intracranial hemorrhage. Here, we report an extremely rare case of intramedullary spinal cord tuberculoma in a 30-year-old man presented with paraparesis in a patient under treatment for TBM. Our case report highlights that tuberculoma should be considered as a differential diagnosis for intramedullary space occupying lesions. The clinical features and medical imaging supplemented by advanced magnetic resonance imaging techniques helps in evaluating different types of tuberculous lesions and in making the diagnosis of brain and spine TB confidently.

Utility of Ultrasound Imaging Features in Diagnosis of Breast Cancer

Background Currently, breast cancer (BC) is considered one of the most prevalent cancer worldwide in women and represents a global health challenge. Early diagnosis is the keystone in the management of BC patients. This study aims to assess the utility of ultrasonography (US) features of malignancy in the diagnosis of BC. Methods This retrospective cross-sectional study involved the electronic records of 326 female patients who were diagnosed with BC. A cross-tabulation test was performed to identify the association between the presence of each US feature (yes/no), and the final US diagnosis (benign/malignant). The strength of association of each feature was measured using the odds ratio (OR) which was assumed to be significant when > 1, with a 95% confidence interval (CI). Results The mean age of the female patients involved in this study was 45.36 ±12.16 years old (range, 17-90 years). Cross-tabulation test showed a significant association between the malignancy tumor and the irregular shape of the lesion (p < 0.001, OR=7.162, CI 2.726-18.814), non-circumscribed margins (p < 0.001, OR = 9.031, CI 3.200-25.489), tissue distortion (p < 0.001, OR = 18.095, CI 5.944-55.091), and the lymph node enlargement (p < 0.001, OR = 5.705, CI 2.332-13.960). Conclusion US imaging features of malignancy have a high sensitivity and positive predictive value for detection of the BC. However, the specificity of breast US imaging features is much lower because of the overlapping features in benign and malignant breast lesions. Breast lesions with an irregular shape, not circumscribed irregular or spiculated margins, hypo-echogenicity, tissue distortion, and those with lymphadenopathy have the highest likelihood of malignancy despite the low specificity. US is a highly valuable, safe, and affordable imaging modality with high diagnostic accuracy for BC.

The Neoplasms Mimicker: A Pictorial Review of Hydatid Disease

Hydatid cyst is a common name for the larval stage of a tapeworm species of the genus Echinococcus granulosus, which is transmitted from animals to humans via the fecal–oral route. Hydatid cysts predominantly affect the liver (75%), followed by the lung (15%), and they can affect many organs in the human body. Medical imaging modalities are the keystone for the diagnosis of hydatid cysts with high sensitivity and specificity. Ultrasound imaging with high resolution is the first choice for diagnosis, differential diagnosis, staging, establishing a role in interventional management, and follow-up, and it can differentiate Type I hydatid cysts from simple liver cysts. Unenhanced computed tomography (CT) is indicated where or when an ultrasound is unsatisfactory, such as with chest or brain hydatid cysts, when detecting calcification, and in obese patients. Magnetic resonance imaging (MRI) is superior for demonstrating cyst wall defects, biliary communication, neural involvement, and differentiating hydatid cysts from simple cysts using diffusion-weighted imaging (DWI) sequences. According to the phase of growth, hydatid cysts occur in different sizes and shapes, which may mimic benign or malignant neoplasms and may create diagnostic challenges in some cases. Hydatid cysts can mimic simple cysts, choledochal cysts, Caroli’s disease, or mesenchymal hamartomas of the liver. They can mimic lung cystic lesions, mycetoma, blood clots, Rasmussen aneurysms, and even lung carcinomas. Differential diagnosis can be difficult for arachnoid cysts, porencephalic cysts, pyogenic abscesses, and even cystic tumors of the brain, and can create diagnostic dilemmas in the musculoskeletal system.

The Diagnostic Deceiver: Radiological Pictorial Review of Tuberculosis

Tuberculosis (TB) is a bacterial infection with Mycobacterium tuberculosis; it is a public health problem worldwide and one of the leading causes of mortality. Since December 2019, the COVID-19 pandemic has created unprecedented health challenges and disrupted the TB health services, especially in high-burden countries with ever-increasing prevalence. Extrapulmonary and even pulmonary TB are an important cause of nonspecific clinical and radiological manifestations and can masquerade as any benign or malignant medical case, thus causing disastrous conditions and diagnostic dilemmas. Clinical manifestations and routine laboratory tests have limitations in directing physicians to diagnose TB. Medical-imaging examinations play an essential role in detecting tissue abnormalities and early suspecting diagnosis of TB in different organs. Radiologists and physicians should be familiar with and aware of the radiological manifestations of TB to contribute to the early suspicion and diagnosis of TB. The purpose of this article is to illustrate the common radiologic patterns of pulmonary and extrapulmonary TB. This article will be beneficial for radiologists, medical students, chest physicians, and infectious-disease doctors who are interested in the diagnosis of TB.

Subtle morpho-functional kidney changes in type-2 diabetes mellitus patients: A duplex ultrasound assessment

Objectives:

Diabetes mellitus (DM) is a common endocrine disease with serious effects on multiple organs including the kidneys. This study aimed to investigate the subtle effects of type 2 DM (T2DM) on the kidneys.

Methods:

This was a prospective case-control study conducted in the Radiology Department of University of Science and Technology Hospital (USTH) campus, Sana’a, Republic of Yemen, from 1 January 2020 to 31 November 2020. The renal length (RL), renal width (RW), resistive index (RI), and pulsatility index (PI) were prospectively measured in patients with T2DM and healthy controls. The results were compared using the independent samples t-test. Comparisons were likewise performed between patients with controlled DM and patients with uncontrolled DM.

Results:

A total of hundred individuals, 50 diabetic patients and 50 controls, were enrolled in this study. Their mean age was 54 ± 7.88 years (range: 40–75 years). The RL, RI, and PI of both kidneys were significantly higher in T2DM than in the control group. Moreover, the RL, RI, PI and creatinine were slightly higher in patients with uncontrolled than in those with controlled DM.

Conclusion:

T2DM has significant accentuating effects on the RL, RI and PI associated with low effective renal plasma flow, even before acute kidney injury or chronic kidney disease diagnosis, which may be attenuated by careful regulation of DM. Ultrasound Doppler is a highly valuable imaging modality for evaluating the subtle effects of T2DM on kidney dimensions and blood flow. The RI can be implemented as a tool for the early diagnosis of kidney disease and contribute to slowing the disease progression and preventing renal failure.

Diagnostic features of tuberous sclerosis complex: case report and literature review

Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic syndrome that is caused by mutations in the tumour suppressor genes TSC1 or TSC2 which causes multiorgan growths. TSC presents at any age as a wide range of clinical and phenotypic manifestations with varying severity. The main goal of this article was to state two cases of TSC and review the most commonly reported major and minor diagnostic clinical features and the most common features that led to an investigation of possible TSC diagnosis. Herein, we report two cases of TSC, which both presented with seizures during the first 6 months of life. Case 1 presented with multiple types of seizures from 6 months of age and was diagnosed by multiple calcified subependymal nodules (SENs) detected by computed tomography and magnetic resonance imaging (MRI). Case 2 presented with seizures from 3 months of age and was diagnosed prenatally when a tumour was seen in her heart during antenatal ultrasonography. In conclusion, the literature review revealed that neurological manifestations (mainly seizures) were the main feature that led to investigation and diagnosis of TSC followed by abdominal manifestations (mainly renal features) and antenatal follow-up imaging. Other manifestations in skin, chest, eyes, teeth and heart rarely led to TSC diagnosis. In some cases, TSC was incidentally discovered by medical imaging. The cortical tubers, SENs, and subependymal giant cell astrocytomas brain lesions were the most commonly reported major features. Skin features including angiofibromas, ungual fibromas and shagreen patch were the second most common major features reported in the literature. However, skin manifestations were not a common led to investigation and diagnosis of TSC. Renal features, mainly angiomyolipomas (AMLs), were the third most common major feature reported. Medical imaging plays an essential role in diagnosis of TSC, and clinical features are important clues that lead to investigation for the disease.

Incidentally discovered Kawasaki disease in an adult man

Kawasaki disease (KD) is a systemic vasculitis of unknown cause which usually diagnosed in small children. However, KD can be present as coronary disease in adults even with no history of the disease in childhood. Here, we describe a case of KD in a 42-year-old male patient presented with severe retrosternal chest pain radiating to the left arm and provisionally diagnosed as acute coronary disease. Coronary artery ectasia and multiple aneurysms have been confirmed by coronary angiography that led to the diagnosis of KD. The patient was treated with Aspirin 81 mg orally once daily, Apixapan 5 mg orally twice daily, Rosuvastatin 40 mg orally once daily, Bisoprolol 5 mg orally once daily, and omeprazole 20 mg orally once daily. The patient was improved and discharged with anticoagulant drugs for life. Physicians should be aware that KD can be present as coronary disease in adults even with no history of the disease in childhood and has a limited treatment options due to unfavorable coronary anatomy.

Myxopapillary ependymoma with interval postoperative CSF seeding: A report of an unusual case

Myxopapillary ependymoma (MPE) is a unique slow-growing benign (WHO grade 1) subtype of spinal cord ependymoma arising predominantly in the filum terminale. Despite its benign nature, it occasionally disseminates through the cerebrospinal fluid and metastasizes to distant sites. Here, we report an extremely rare case of MPE with interval CSF seeding and metachronous metastasis in a 47 -year-old female presented as a gradually increasing low back pain for three months with bilateral radiculopathy down to the knees. Magnetic resonance imaging (MRI) showed an intradural extramedullary spinal mass of iso-intense signal to the cord on T1 weighted-images (WIs), heterogeneous, predominantly hyperintense signal on T2WIs with homogenous enhancement after contrast administration. L2 laminectomy with gross total resection (GTR) was performed, and histopathological results confirmed the diagnosis of MPE. Adjuvant radiotherapy was administered, followed by series of MRI scans. 28 months after GTR, Lumbar MRI showed multiple tiny enhancing nodules in the cauda equina. 44 months follow-up whole spine MRI revealed multiple intradural extramedullary nodules throughout the entire spine. The largest one measures about 1.5cm opposite to T3 -T4 intervertebral disc space. The patient underwent T3 and T4 laminectomy and GTR under general anesthesia using microsurgical techniques, and the histopathological result came with the diagnosis of MPE.

A rare phenotype of breast hydatid cyst causing misdiagnosis and unnecessary intervention: a case report

Hydatid cyst (cystic echinococcosis) is a chronic parasitic infection by the larval stage of the cestode that is called Echinococcus granulosus (E. granulosus) resulting in the development of cystic lesions in animals and humans. In this report, we describe a rare phenotype of hydatid cyst in the breast of a 23-year-old female presented with breast mass in the left upper outer quadrant for 3 months with palpable left axillary lymph nodes. Both US and mammography provided a picture of complex suspicious cystosolid lesion with amorphous micro-calcification (BIRAD-4A). Surgical consultation was performed and Tru-Cut biopsy was recommended. Histopathology results revealed multiple viable protoscolices of E. granulosus and suggested the final diagnosis of breast hydatid cyst. The patient returned with ruptured and infected hydatid cyst of the breast and started treatment with Albendazole 400 mg twice daily in addition to antibiotics. Following-up after two months of Albendazole treatment showed a dramatic shrinkage in the size of the cystic lesion. In conclusion, hydatid cyst should be considered as a differential diagnosis of any cystic or cystosolid lesion in the breast and any organ in the body from head to toe apart from the hair and nails. Radiologists should be aware to the benign lesions that may mimic breast cancer to avoid misdiagnosis and unnecessary invasive procedures and consequent complications.

Autoamputated pharyngeal hairy polyp presented with aero-digestive obstruction: A case report

A pharyngeal hairy polyp (HP) is a rare benign mass that can be surgical detached with few complications. In this report, we describe a hairy polyp in a 7-day-old neonate presented with intermittent respiratory distress and feeding difficulties since birth. Neck computed tomography was performed, and demonstrated a well-defined pedunculated heterogeneous mass arising from the right lateral wall of the nasopharynx extending downward and nearly completely obstructing of the nasopharynx and oropharynx. The central part of the mass was found relatively dense surrounded by low attenuation fatty components with enhancement of the outer wall of the mass. The provisional diagnosis was pharyngeal HP. After autoamputation at the seventh day old, HP was analyzed via histopathology examination that showed a mixture of various ectodermal and mesodermal tissues including skin, cartilage, adipose and fibrous tissue. The patient fully recovered with no residual clinical features. We report this case to elucidate the possibility of this strange behavior of pharyngeal HP.

Frequent clinical and radiological manifestations of the Novel SARS-CoV-2: A review article

Coronavirus disease 2019 (COVID-19) is a highly infectious disease caused by the novel “severe acute respiratory syndrome coronavirus-2” (SARS-CoV-2) and is rapidly spreading worldwide. This review is designed to highlight the most common clinical features and computed tomography (CT) signs of patients with COVID-19 and to elaborate the most significant signs indicative of COVID-19 diagnosis. This review involved five original articles with both clinical and radiological features of COVID-19 published during Jan and Mar 2020. In this review, the most frequent symptoms of COVID-19 were fever and cough. Myalgia, fatigue, sore throat, headache, diarrhea, and dyspnea were less common manifestations. Nausea and vomiting were rare. Ground-glass opacity (GGO) was the most common radiological finding on CT, and mixed GGO with consolidation was reported in some cases. In addition, elevated C-reactive protein and lymphopenia are the pertinent laboratory findings of COVID-19. CT is an effective and important imaging tool for both diagnosis and follow-up COVID-19 patients with varied features, duration, and course of the disease. Bilateral GGOs, especially in the periphery of the lungs with or without consolidation, are the hallmark of COVID-19.

[Evolution and progress of lung transplantation: An analysis of a cohort of 600 lung transplant patients at the Hospital Foch]

Lung transplantation is deemed to be the only effective therapy that improves survival for patients with end stage lung disease. The aim of our study was to examine the progress achieved over the last two decades and to demonstrate the effectiveness and safety of this treatment.

METHODS

A retrospective analysis of a cohort of 600 consecutive lung transplant patients treated at the hospital Foch (Suresnes, France) between 1988 and 2014. They were split into three groups of 200 patients each: 1988-2004, 2004-2011, 2011-2014.

RESULTS

Time and mortality on waiting list, perioperative mortality, the incidence of acute rejection in the first year and chronic lung allograft dysfunction (CLAD) at 5 years posttransplantation, have all decreased. Global survival at 1 and 5 years for the 600 patients increased from 78% and 57% to 86% and 75% respectively for the 200 last patients. Patients with cystic fibrosis have a better 5 year survival than those with emphysema or pulmonary fibrosis (68% vs. 54 % for emphysema and 37% for fibrosis). For the last 200 patients, 5 year survival is 81% for CF patients, 78 % for emphysema and 47% for fibrosis. Emergency transplantation had a 60% 5 years survival. Proliferative complications, arterial hypertension and renal function impairment are being monitored long term.

CONCLUSION

The twenty-five years experience shows a consistent improvement in the results of lung transplantation which is now accepted as the only effective curative treatment for end stage lung disease.

Antibody-Mediated Rejection in Lung Transplantation: Clinical Outcomes and Donor-Specific Antibody Characteristics

In the context of lung transplant (LT), because of diagnostic difficulties, antibody-mediated rejection (AMR) remains a matter of debate. We retrospectively analyzed an LT cohort at Foch Hospital to demonstrate the impact of AMR on LT prognosis. AMR diagnosis requires association of clinical symptoms, donor-specific antibodies (DSAs), and C4d(+) staining and/or histological patterns consistent with AMR. Prospective categorization split patients into four groups: (i) DSA positive, AMR positive (DSA(pos) AMR(pos) ); (ii) DSA positive, AMR negative (DSA(pos) AMR(neg) ); (iii) DSA limited, AMR negative (DSA(Lim) ; equal to one specificity, with mean fluorescence intensity of 500-1000 once); and (iv) DSA negative, AMR negative (DSA(neg) ). AMR treatment consisted of a combination of plasmapheresis, intravenous immunoglobulin and rituximab. Among 206 transplanted patients, 10.7% were DSA(pos) AMR(pos) (n = 22), 40.3% were DSA(pos) AMR(neg) (n = 84), 6% were DSA(Lim) (n = 13) and 43% were DSA(neg) (n = 88). Analysis of acute cellular rejection at month 12 showed higher cumulative numbers (mean plus or minus standard deviation) in the DSA(pos) AMR(pos) group (2.1 ± 1.7) compared with DSA(pos) AMR(neg) (1 ± 1.2), DSA(Lim) (0.75 ± 1), and DSA(neg) (0.7 ± 1.23) groups. Multivariate analysis demonstrated AMR as a risk factor for chronic lung allograft dysfunction (hazard ratio [HR] 8.7) and graft loss (HR 7.56) for DSA(pos) AMR(pos) patients. Our results show a negative impact of AMR on LT clinical course and advocate for an early active diagnostic approach and evaluation of therapeutic strategies to improve prognosis.

Small bowel feces sign in association with occlusive mesenteric ischemia

Small bowel feces sign (SBFS) is a computed tomography (CT) finding that appears as fecal like material in dilated small bowel loops. This sign is usually seen in association with gradually progressive small bowel obstruction. We present a case of occlusive mesenteric ischemia in which the SBFS appeared on CT scan early on in the course of the disease. We put forward a suggested alternative mechanism to the appearance of this sign in association with mesenteric ischemia. The SBFS might have the potential to serve as an early sign of mesenteric ischemia on CT scan.

Pulmonary arterial hypertension masquerading as severe refractory asthma

Once the diagnosis of pulmonary arterial hypertension is established, wheezing and chronic cough are rarely described during the course of the disease. The present study reports on two nonsmoking patients with severe pulmonary arterial hypertension, confirmed by right-heart catheterisation, who developed chronic cough, wheezing and irreversible obstructive lung disease masquerading as adult-onset severe refractory asthma. In both cases, extrinsic proximal airway obstruction by dilated pulmonary arteries was demonstrated by fibreoptic bronchoscopy and computed tomography of the chest. The present observations add dilatation of the central pulmonary arteries with compression of the mainstem bronchi to the list of masqueraders of asthma in patients with pulmonary arterial hypertension.

Recurrence of prolactin-producing endometrial stromal sarcoma with sex-cord stromal component treated with progestin and aromatase inhibitor

INTRODUCTION

Endometrial stromal tumors with sex-cord-like elements are relatively rare. We report a case of this neoplasm with prolactin as a tumor marker for recurrent disease. We also report response of recurrent disease to progesterone and aromatase inhibitor.

CASE REPORT

A 48-year-old woman was diagnosed with Stage I endometrial stroma sarcoma with sex-cord component at the time of hysterectomy for presumed fibroid uterus. One and a half years later, she presented with recurrent disease in the abdomen associated with breast tenderness, galactorrhea, and an elevated prolactin level. She received three cycles of BEP (Bleomycin, Etoposide, Cisplatin) with partial response and followed by an optimal debulking procedure. Two out of a six additional planned cycles of BEP were administered with complete tumor response and normalized prolactin level. Second recurrence, 9 months later, again presented with galactorrhea and rising prolactin. Disease was progressive through three cycles of Docetaxel and Gemcitabine therapy, but had an objective response to treatment with anastrozole and megestrol acetate. Prolactin level normalized. Two years later there is stable disease and the patient remains symptom-free.

DISCUSSION

Endometrial stromal sarcoma with sex-cord stromal component may be hormonally functional. Similarly to pure endometrial stromal sarcomas, they may respond to hormonal treatment, and further study is warranted.

Comparative pharmacokinetics of diphenhydramine in camels and horses after intravenous administration

The pharmacokinetics of diphenhydramine (DPHM) was compared in camels (n = 8) and horses (n = 6) following intravenous (i.v.) administration of a dose of 0.625 mg/kg body weight. In addition, the metabolism and urinary detection time of DPHM was evaluated in camels. The data obtained (median and range in brackets) in camels and horses, respectively, were as follows. The terminal elimination half lives (h) were 1.58 (1.13-2.58) and 6.11 (4.80-14.1), and the total body clearances (L/h per kg) were 1.42 (1.13-1.74) and 0.79 (0.66-0.90). The volumes of distribution at steady state (L/kg) were 2.38 (1.58-4.43) and 5.98 (4.60-8.31) and the volumes of the central compartment of the two compartment pharmacokinetic model were 1.58 (0.80-2.54) and 2.48 (1.79-3.17). All the pharmacokinetic parameters in camels were significantly different from those of horses. Five metabolites of DPHM were tentatively identified in the camel's urine. Two metabolites, diphenylmethoxyacetic acid and 1-(4-hydroxyphenyl)-phenylmethoxyacetic acid, were present in the acid fraction. Two metabolites, desamino-DPHM and diphenylmethanol, were identified in the basic fraction, in addition to DPHM itself, which was present mainly as a conjugate. Even after enzymatic hydrolysis, DPHM could be detected for up to 24 h in camels after an i.v. dose of 0.625 mg/kg body weight.

Comparative disposition of tripelennamine in horses and camels after intravenous administration

The pharmacokinetics of tripelennamine (T) was compared in horses (n = 6) and camels (n = 5) following intravenous (i.v.) administration of a dose of 0.5 mg/kg body weight. Furthermore, the metabolism and urinary detection time was studied in camels. The data obtained (median and range in brackets) in camels and horses, respectively, were as follows: the terminal elimination half-lives were 2.39 (1.91-6.54) and 2.08 (1.31-5.65) h, total body clearances were 0.97 (0.82-1.42) and 0.84 (0.64-1.17)L/h/kg. The volumes of distribution at steady state were 2.87 (1.59-6.67) and 1.69 (1.18-3.50) L/kg, the volumes of the central compartment of the two compartment pharmacokinetic model were 1.75 (0.68-2.27) and 1.06 (0.91-2.20) L/kg. There was no significant difference (Mann-Whitney) in any parameter between camels and horses. The extent of protein binding (mean +/- SEM) 73.6 + 8.5 and 83.4 +/- 3.6% for horses and camels, respectively, was not significantly statistically different (t-test). Three metabolites of T were identified in urine samples of camels. The first one resulted from N-depyridination of T, with a molecular ion of m/z 178, and was exclusively eliminated in conjugate form. This metabolite was not detected after 6 h of T administration. The second metabolite, resulted from pyridine ring hydroxylation, had a molecular ion of m/z 271, and was also exclusively eliminated in conjugate form. This metabolite could be detected in urine sample for up to 12 h after T administration. The third metabolite has a suspected molecular ion of m/z 285, was eliminated exclusively in conjugate form and could be detected for up to 24 h following T administration. T itself could be detected for up to 27 h after i.v. administration, with about 90% of eliminated T being in the conjugated form.

Adenocarcinoma of the ileum with an enterotubal fistula presenting as an adnexal mass

Small bowel adenocarcinomas account for 3% of gastrointestinal malignancies, and 20 to 25% of these arise in the ileum. Clinical presentation is variable, and early diagnosis is difficult. A 56-year-old postmenopausal woman presented with crampy abdominal pain, anorexia, and weight loss. Pelvic examination and ultrasound revealed a 6 x 8-cm complex right adnexal mass. At laparotomy, en bloc resection of the right adnexa and the densely adherent ileal segment was performed along with a hysterectomy and a left salpingo-oophorectomy. The final pathology showed a moderately differentiated invasive adenocarcinoma of the ileum with a malignant enterotubal fistula. This is the first case reported in the literature of an ileal adenocarcinoma with a tubal fistula masquerading as an adnexal mass.

High levels of CA-125 in a case of a parasitic leiomyoma presenting as an abdominal mass

A 32-year-old woman presented with increasing abdominal girth and discomfort secondary to a 18-week-size mass and a CA-125 level of 1539. She underwent an exploratory laparotomy and resection of a parasitic fibroid following which the CA-125 levels decreased and normalized within a month. A review of English literature indicates that association of raised CA-125 levels with fibroids is inconsistent and very modest and such high levels have not been previously reported.

Mucinous adenocarcinomas of the vulva

An 80-year-old nullipara had a 2.0-cm cystic tumor of the right labium majus. Histologic diagnosis was mucinous eccrine carcinoma. Seventy-five percent of these rare skin adnexal tumors arise on the face, eyelid, or scalp; but none has been reported on the vulva. Indolent localized growth is usual with regional nodal spread in 11% and distant metastases in 3%. A 67-year-old multipara had a 1.2-cm polypoidal nodule of the posterior fourchette. Histologically, a colonic type mucinous carcinoma was arising within a villous adenoma. Mucicarmine and CEA stains were positive. Extensive workup failed to reveal other primary cancers in either patient. Both patients are well 19 and 17 months after radical vulvectomies and node-negative groin dissections. These cases illustrate further the diversity in cell type and biologic behavior of vulvar adenocarcinomas.

Teenage pregnancy: are teenagers a high risk group?

OBJECTIVES

To study health profile of pregnant teenagers and their pattern of utilization of primary health care services in comparison with pregnant women aged 20-35 years in Abha, Saudi Arabia.

STUDY DESIGN

A cohort of 1938 Saudi pregnant women (214 teenagers less than 20 years and 1724 aged 20-35 years) was selected by stratified random sampling technique. They were screened for anemia and hypertension using WHO criteria and followed until delivery to observe the method of delivery.

RESULTS

The prevalence of anemia (9.6% and 12.0%, respectively) and hypertension (1.1% and 3.5%, respectively) was not significantly different among primigravida of both age groups. The same trend was observed among multigravida. Follow-up showed that the rate of abnormal deliveries among primigravida of both groups was not significantly different, and even lower among multigravida teenagers. Pregnant women in both groups had similar average prenatal visits (6.6 +/- 1.1 and 6.7 +/- 1.2 respectively, P < 0.05) and the majority contacted the primary health care center early in pregnancy (87.4% and 88.9%, respectively, P < 0.05).

CONCLUSION

These results indicate that pregnant teenagers are not a high risk group if good prenatal care is provided.

Glomus tympanicum chemodectoma: unusual radiological findings

A 64-year-old Qatari female, with a one-year history of right otorrhoea and deafness, had a reddish-white mass projecting into the right ear canal, through the tympanic membrane, that proved histopathologically to be a paraganglioma. Computerized tomography (CT) of the temporal bones showed extensive destruction of the right mastoid bone, the posterior ear canal wall, and the sinus plate, with total disruption of the ossicles, simulating a malignant tumour, which is unusual for a middle ear paraganglioma.

Granular cell tumour of the larynx in an eight-year-old girl

Granular cell tumour is a rare benign neoplasm, that can affect many parts of the body, as single or multiple lesions. It is more common in black people and females. Typically it occurs between the fourth and fifth decades of life, with the median age for the laryngeal variety as 36 years. About 30 to 50 per cent occur in the tongue and 30 per cent in the skin. A case of granular cell tumour of the larynx is reported in an eight-year-old girl, presenting with hoarseness of voice. She was successfully treated with local excision of the tumour. This tumour is rare in the larynx where it is more common in males than females although granular cell tumours are found more frequently in females generally. For these reasons the authors suspect that their case, of a laryngeal granular cell tumour occurring in an eight-year-old girl might be the youngest to be reported.

An epidemiologic study of primary health care service utilization of summer visitors to Abha, Asir, Saudi Arabia

Primary health care (PHC) service utilization by summer visitors to Abha, Saudi Arabia was studied among 227 families including 1443 persons attending the Al-Manhal Primary Health Care Center (PHCC) during August 1991. Summer visitors added an excess load on PHC services: 1.8% for preventive activities, 3.3% for diagnostic activities and 17.4% for curative activities. A significant excess of utilization of curative PHC activities was observed among summer visitors compared to residents. On the other hand, a significant decrease in utilization of preventive and diagnostic PHC services was noted among summer visitors. This study demonstrates the importance of augmenting PHCCs with staff and supplies in residential areas during the summer to cope with the situation and of providing proper and adequate PHC services. More health education is needed to inform people about importance of preventive PHC for better utilization of the available services.