Neurosurgery in the Middle East: life under fire.
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Biomedical subjects
Publications and source records attributed to F S Haddad.
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An unusual case of a double testicular tumor, with different histology and the same marker chromosome, led to a search of the literature for cases of testicular tumors that were double, bilateral, or familial. The literature on abnormal chromosomes in tumors of the testis is also reviewed. After a discussion of the facts, it is suggested that most of the histological variants of germ cell tumors of the testicle are so closely related that they could be grouped together under the title of 'orchidomata'.
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We report a case of a chronic hematocele and describe its characteristics. The specific pathological lesion of a chronic hematocele consists of several neovascular formations covered by layers of fibrin. These lesions give characteristic ultrasonic and computerized tomographic images, consisting of several sharply circumscribed small spherical areas of soft tissue. When correctly interpreted before the initiation of surgical treatment, these images will obviate an orchiectomy, which is not always necessary.
An identical abnormal chromosome, i(12p), and a marker chromosome of unknown origin were seen in 2 tumors of different histology (seminoma and embryonal carcinoma) in the same testis. A younger brother of the patient also had undergone orchiectomy for 2 seminomas in the left testis 2 years previously. These findings are discussed in relation to the possible cellular background of testicular tumors and their genetic parameters.
We present a case of cerebral giant serpentine aneurysm (GSA) and propose a definition of GSA. Our literature review disclosed only 16 cases, including our own, that fit our criteria. GSAs belong to the subgroup of giant aneurysms, but are distinct from giant saccular and fusiform aneurysms. We discuss their specific characteristics.
Several months (an average of 12.86 months) after perineal needling of the cancerous prostate for the purpose of obtaining tissue for biopsy, a tumor nodule becomes clinically evident in the subcutaneous tissue of the perineum, at the site of the needling in 0.34% of the cases. This nodule presents the same histological picture as the biopsy of the prostatic tumor. This is a review of 15 such cases (12 collected from the literature and an additional three unpublished cases, two of which are personal observations). At the time of needling, no metastases could be clinically detected in any of the patients; the serum acid phosphatase was normal in 73% of them. The average age of the patients was 65.66 years. The perineal nodule was tender in 40% of the cases; its average size was 2.5 cm. Excision of the nodule was the most frequently employed form of management. At the time of reporting, 60% of the patients were living and well, for an average of 18.56 months after excision. In order to prevent perineal implantation, especially in patients who are at risk, it is suggested that a fine needle be employed to obtain prostatic tissue for biopsy, and that every possible therapeutic effort be made.
A case report of a rectal carcinoma metastasizing to the penis is reviewed along with a total of 44 similar cases reported in the world literature. Pertinent arguments are presented in favor of yet another possible route of metastases, namely the perineural route, which has not been considered previously. Cavernosography provides valuable information about the extent of tumor spread; used more often, it would lead to recognition of the rare opportunity when an aggressive surgical approach might achieve prolonged survival.
The recent literature on abdominal tuberculosis is comprehensively reviewed, and seven cases of abdominal tuberculosis are reported, including four belonging to three generations of the same family. Possible explanations for this familial incidence are discussed. Abdominal tuberculosis is not so rare; 135 cases have recently been reported from the United States and Canada. This review dissipates four common misconceptions: abdominal tuberculosis is rare, tuberculosis is a stigmata of the poor, abdominal tuberculosis is always associated with active pulmonary tuberculosis, and chronic abdominal pathology is synonymous with regional enteritis. Since the description of regional enteritis, more and more cases of chronic intestinal pathology have been labeled "regional enteritis." The fact that intestinal tuberculosis is rather uncommon should not automatically lead to the diagnosis of regional enteritis. The possibility that many cases of so-called regional enteritis may, in fact, be a stage or a variant of abdominal tuberculosis, is worth considering. Abdominal tuberculosis is not a relic of the past. It remains a real challenge to the diagnostic acumen and therapeutic skills of both the internist and the surgeon.
The doubling time (DT) of human prostatic cancer is calculated for the first time; its various parameters and the relative importance of each are reviewed. A crude volume-doubling time (DTcv), a theoretical doubling of the number of cells (DTt), and an annual doubling rate (ADR), are defined and calculated for each of 12 patients who had undergone needling of the prostate for diagnostic purposes and in whom tumor cells were implanted in the track of the biopsy needle and had grown into a subcutaneous perineal nodule. The harmonic average DTcv was six days and DTt eight days, and the average ADR was 45 doublings per year. From the study of the calculated DTs and ADRs, it became obvious that the 12 patients fell into three distinct groups: Group I = slow tumor growth rate, an average ADR of 9 doublings per year, and a harmonic average DTt of forty days; Group II = medium tumor growth rate, an average ADR of 35 doublings/year, and a harmonic average DTt of ten days; and Group III = rapid tumor growth rate, an average ADR of 100 doublings/year, and a harmonic average DTt of four days.
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This is a report concerning a unique combination of Alzheimer's disease with the following refluxes: buccosalivary, gastroesophageal, vesicoureteral, urethroprostatic and urethrovesicular, along with neurogenic bowel and neuropathic bladder. A second patient with Alzheimer's disease and vesicoureteral reflux is reported. The possible etiopathology of these unusual refluxes and their relation to Alzheimer's disease are discussed.
Although uncommon, the so-called spontaneous or idiopathic rupture of the bladder is not rare; 84 cases have so far been reported. A common denominator in almost all these cases is that the rupture is intraperitoneal and that it is often unsuspected, the actual diagnosis being made at autopsy, after surgical exploration or, as in our case, retrospectively. We are proposing that bladder infarction may be the common denominator for all the contributary etiological factors, which include the following: long-term indwelling catheter, alcohol, medication such as bethanechol or methamphetamine, and weakening of the bladder wall as from a neuropathic bladder, a pseudodiverticulum, a chronic infection or a combination of these factors. The symptoms of intraperitoneal rupture of the bladder consist of the triad: pain, difficulty or inability to void and rigidity of the abdominal wall. Elevation of the blood urea seems to be a sensitive indicator of intraperitoneal bladder rupture. The most valuable diagnostic tool remains cystography. Early diagnosis requires a high degree of clinical suspicion and an increased awareness by the surgeon of the possibility of intraperitoneal bladder rupture.
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Primary transitional cell carcinoma of the ureter is a relatively rare cancer. A case of transitional cell carcinoma of the mid-portion of the ureter in an adult male has been studied cytogenetically and has been found to have trisomy of chromosome #7 (+7) as the only karyotypic abnormality. In an earlier instance of transitional cell carcinoma of the ureter, we observed trisomy 7 together with monosomy 9 and an isochromosome for 5p. The relation of this observation to the cytogenetic findings in transitional cell carcinoma of the bladder is discussed and their possible significance evaluated. The rarity of the cytogenetic findings in these tumors is stressed, as is the possible role played by the chromosomal change in this condition, which may possibly involve the c-erb B oncogene.