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Volume No. 20 2017-03-01 8
Volume No. 21 2018-01-01 5
Volume No. 22 2018-06-01 6

CONGENITAL CYSTIC ADENOMATOID MALFORMATION: CASE REPORT

OMERM IBRAHEEM, SAAD A MOUSA, Myada A Ibrahim

Congenital cystic adenomatoid malformation is a rare non hereditary lesion of the lung. In the neonatal period it presents with severe progressive respiratory distress due to expansion of the affected lung. We present a neonate in whom this condition was diagnosed and managed at Omdurman Military Hospital, pediatric surgery unit. In this case the clinical, radiological as well as surgical outcome highlighted.

Clinical presentation and etiology of pulmonary fibrosis among Sudanese patients

Alaa S A, Ahmed S Ibrahim, Ahmed B Ali, Omer E Y Elhag, Abdelrahman M Abukanna, Ahmed H Sulaiman, Hafiz O IbnIdris

Objective: This study was performed to identify the clinical presentations and etiology of pulmonary fibrosis in adult Sudanese patients.

Materials and Methods: This descriptive cross-sectional hospital-based study was conducted at Alshaab Teaching Hospital from May 2013 to May 2014. One hundred patients with pulmonary fibrosis were included after they had provided informed written consent. We collected data using a closed-ended questionnaire containing items regarding demographic data and clinical symptoms (cough, shortness of breath, chest pain, and weight loss). We examined all patients for clubbing, inspiratory crackles, cyanosis, and evidence of pulmonary hypertension. Chest X-ray and high-resolution computed tomography (HRCT) images were reviewed for all patients. We performed echocardiography for all patients to check for evidence of pulmonary hypertension. Data were analyzed using SPSS version 22 (IBM Corp., Armonk, NY).

Results: The mean age of the patients was 52 years. The main presenting complaints were cough and dyspnea (89% and 84%, respectively). Clubbing and inspiratory crackles were found in 91% and 74% of the patients, respectively. The main causes of pulmonary fibrosis were idiopathic disease (49%) and tuberculosis (34%). X-rays showed reticular shadows in 95% of patients. Honeycombing, ground-glass, and nonspecific appearances were found on HRCT in 71%, 22%, and 7% of patients, respectively. Echocardiography showed pulmonary hypertension in 46% of patients.

Conclusion: Cough and dyspnea were the main presenting symptoms. A honeycombing appearance was found in most of the patients using HRCT, while pulmonary hypertension was the main echocardiographic finding.

Keywords: pulmonary fibrosis, reticular shadows, ground-glass appearance

The Status of  Procoagulant Tissue  Factor-bearing  Microvesicles Among Saudi Children with Sickle Cell Disease During Steady State

Orwa G. Elhussein, Hassan A. Hamali, Mustafa A. ALzaheri, Fathelrahman E. Ahmed

Introduction: Sickle cell disease (SCD) is a common genetic disorders characterized by episodic occlusion of the microcirculation leading to life-threating complications, including thrombosis. Coagulation activation is a prominent feature of SCD, as shown, among others, by an increased expression of tissue factor (TF).

Objectives: To measure and compare the levels of plasma circulating tissue factor bearing microvesicles (TF-MVs) in Saudi children with SCD in steady state and in matched healthy control (MHCs).
Method: This was a prospective observational hospital-based study in which citrated whole blood was collected from 102 SCD children homozygous for sickle hemoglobin (HbSS) (aged from 2 to 18 years-old) and 51 HMCs. TF-MVs were measured using an indirect ELISA method.

Results: TF-MVs level in Saudi children with SCD is significantly elevated than in MHCs (0.82 vs 0.50 pg/ml) (P = < 0.0001).The level of TF-MVs in children below age 7 years was comparable to that in normal children.(0.76 vs 0.63 pg/ml,P 0.4). Male children with SCD showed higher levels of TF-MVs in their plasma than female children but that was not statistically significant (0.93  vs 0.77  pg/ml) (P= 0.1).There was no statistically significant correlation between the TF-MVs level and total MVs (r=0.24) (P value 0.06).

Conclusion: This study demonstrated an elevated level of TF-MVs activity in Saudi children with SCD compared to the control. Children below the age of seven years in the study group had a level of TF-MVs comparable to that in the control group. Male children in the study group were observed to have higher level of TF-MVs than females.

Key words: Tissue factor bearing microvesicles, Microvesicles, Sickle cell Disease, Children,Saudi Arabia.

The Surgical Management of Pluero-pulmonary Tuberculosis in Sudan

Dr: Mohammed Elhaj Hassan Abdulmajeed, Prof: Mohamed Elamin Ahmed

The aim of this study is to give a review about tuberculous cases managed by surgery in our country. The study was done at El-Shaab Teaching Hospital which is considered as a referral centre for thoracic surgical cases. All cases in the study have been diagnosed by chest physicians as pulmonary tuberculosis and have commenced the anti-tuberculous treatment.   

Surgery for pulmonary tuberculosis (TB) has become rather limited. However, it is still required for some sequelae and complications. This is a 3 year study (1 year prospective and 2 years retrospective) of cases operated upon for pulmonary TB at El-Shaab Teaching Hospital- Khartoum-Sudan. Patients and methods: A total of 87 cases underwent surgical procedures for various complications of pulmonary TB. After excluding those managed by tube thoracostomy, all cases were taken up for major thoracic surgical procedures under general anaesthesia with double lumen endotracheal tube. 

A total of 51 cases were operated for tuberculous empyema, 22 patients for aspergilloma and pulmonary cavity with recurrent haemoptysis, 8 patients for multi-drug resistant tuberculosis and 6 patients for tuberculous bronchiectasis. Lung resections including lobectomy were done for 31 patients, pneumonectomy for 1 patient and wedge resection for 1 case. Postoperative follow up was done for those patients and there was no death. The main postoperative complication was air leak which is found in 26 patients which resulted in delayed early hospital discharge, but has stopped spontaneously. This complication is just found in patients underwent decortications for tuberculous empyema. Broncho-pleural fistula (BPF) has been found in 4 cases but sealed spontaneously later on. Results were better in haemoptysis where the desired outcome was achieved in all cases of aspergilloma and lung cavity. All patients were improved apart from 6 patients who had advanced progressive tubercular disease.

Conclusion: Surgery for pulmonary TB is the only option for many tuberculous cases with satisfactory results.

Paediatric Abdominal Tumors at Khartoum Teaching Hospital; Pattern and Clinical Profiles

Mr. Amir Abdalla Mohammadin, Omer E. M. Khair, Dr. Hassan. I. A.

Objectives: The aim of this study was to determine the mode of presentations, clinical profile and the sensitivity of imaging in the abdominal tumors in paediatric and types of tumors.

Methods: This was a prospective and retrospective cross sectional study conducted in Khartoum Teaching Hospital in the period between April 2012 to April 2014. Variables studied included clinical presentations, imaging used for work up, types of abdominal tumors with regional distributions, and duration of symptoms.

Results: fifty-eight patients enrolled, males, 55.2 % (n=32), and females, 44.8 %( n=26), ages group range between (28 days-13 years) with mean 4.6 years. 51.7% from the center of Sudan, 27.6% from West, 15.5% from Gezira, and 5.2% from North. Most of them presented with abdominal mass and pain 89.7 %( n=52), fever 74.1% (n=43), anemia 77.6 %( n=45), four (6.9%) of them presented as acute abdomen (intussusceptions), two presented with mass and jaundice. Six presented with urine retention (10.3%). The duration of symptoms (15days - 3 months). The imaging used were, US&CT scan with sensitivity, 67.3% & 80.3%, respectively. Histologically: 91.1% malignant tumors, the rest were benign and two cases; (abdominal TB). Wilm’s tumor 31%(n=18), lymphoma 27.6%(n=16), neuroblastoma 12.1%(n=7),Hepatoblastoma & teratoma 6.9%(n=4) for each, neuroectodermal 3.4%(n=2), adinocarcinoma, fibro sarcoma, rhabdomy-osarcoma and peutz-jegher 1.7%(n=1) for each. Two cases 3.4% were abdominal TB. about nineteen patients (32.8%) died shortly after starting workup (late presentation).

Conclusion: Abdominal mass in paediatric is serious conditions. Good evaluation, awareness with symptoms and signs with reliable imaging and histological investigations; are a corner stone for the early diagnosis and improvement of outcome.

Key words: Solid abdominal mass, Wilm’s tumor, Neuroblastoma, Lymphoma