Biomedical subjects
Publications and source records attributed to M H Ali.
Two cases of chemodectoma of the larynx are presented. Both of them arose from the superior laryngeal glomus in men late in their lives. Pain was the landmark of the disease. Both cases showed very aggressive behaviour. In conclusion, these are malignant tumours which should be treated by total laryngectomy. There is no place for radiotherapy in their treatment.
In 66 endoscopic duodenal biopsies studied retrospectively and in 84 paired duodenal and antral biopsies assessed prospectively campylobacter like organisms were seen in 22 (33%) of the retrospectively examined duodenal biopsies and in 61 (73%) examined prospectively, and in 70 (83%) of antral biopsies. In the duodenum the organisms were mostly confined to the surface epithelium in areas showing gastric metaplasia, while in the antrum they were also found within superficial glands. A strong association was shown between the presence of campylobacter like organisms and histological active duodenal inflammation.
Kikuchi's disease (necrotising lymphadenitis) is characterised by cervical lymphadenopathy in young patients and may be mistaken for malignant disease both clinically and histologically. Microscopically, there is a varying degree of effacement of the lymph node architecture and necrosis with an infiltrate of "histiocytic" cells and absence of polymorphs. The disease is of unknown aetiology. It was originally described in Japan, and only 27 cases have been reported elsewhere (none in the United Kingdom), although it has probably been seen but not recognised. The clinical, histopathological, electron microscopic, and immunohistological findings in four cases of the disease were evaluated.
In six cases of Whipple's disease the characteristic macrophages could be stained immunocytochemically using a first layer antiserum to group B streptococci. Other types of periodic acid Schiff positive macrophages were negative. The staining appears to be due to a rhamnose containing polysaccharide as shown by a blocking test. The method may be useful for confirming the diagnosis in rectal biopsy and peripheral nodes, especially if small intestinal findings are atypical.
A total of 494 patients (90 men and 404 women) attending a sexually transmitted diseases (STDs) clinic in Khartoum, Sudan, were studied to assess the prevalence of chlamydial genital infections. Antibodies to Chlamydia trachomatis serotypes D to K were found in four (4.4%) men and 42 (10.4%) women, and 10 (2.5%) women had antibodies to serotypes A to C.
At a sexually transmitted disease clinic at Khartoum 613 Sudanese women presenting with vaginal discharge were investigated. Specimens were examined by microscopy and culture. Trichomonas vaginalis infestation was found in 123 patients (20.1%), predominantly in the age groups 16-19 years (27.1%) and 46-65 years (27%). Frequency of trichomonal vaginitis was highest (35.9%) among divorced women. Of the pregnant women investigated, 16.3% were found to harbour the parasite. There was no significant difference in the parity of parasitized and non-parasitized patients.
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Nine benign retention (juvenile) large bowel polyps with an unusual histologic appearance, developed in a 23-year-old man at the site of anastomosis 7 years after ureterosigmoidostomy. Benign tumor occurring as a complication of this operation are very uncommon, and no previously reported case has had more than two lesions. The literature is reviewed, with emphasis on the characteristic histological appearance of benign postureterosigmoidostomy polyps.
The light microscopical, histochemical and ultrastructural features of an unusual gastric tumour are presented. Microscopically, the neoplasm showed the features of both a conventional carcinoid tumour and of a mucin-producing adenocarcinoma. The ultrastructural demonstration of individual cells containing both endocrine granules and mucin globules supports the view that gastric enterochromaffin cells are of endodermal origin.
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Sera and ascitic fluid of 26 patients with acute and chronic schistosomiasis were studied for the presence of circulating immune complexes (CIC's), IgG, IgM, IgA, complement C3 and C4, as well as their correlation with the clinical manifestations of the disease. Serum levels of CIC's and IgG were significantly increased in patients with acute S. mansoni and S. haematobium infections and in patients with chronic schistosomiasis. Serum IgA levels were evaluated in 20% of patients with S. mansoni infection, 67% with S. haematobium infections and in 100% of chronically infected patients. Complement C3 levels were normal in all patients. Ascitic fluid analysis revealed the presence of IgG, IgM, IgA, C3 and C4 and high concentrations of CIC's. A significant positive correlation was demonstrated to occur between serum CIC's and IgG, as well as between the serum and ascitic fluid levels of CIC's of chronic patients. These findings also correlated with the degree and severity of the clinical syndrome.
One hundred and thirty-eight male adult patients were examined clinically for STD in two VD clinics in Khartoum Province. Specimens were collected for microbiological investigations. NGU was the commonest STD encountered (35.1%). Next came gonorrhoea (25.9%) and other STD. Syphilis accounted for only 1.3% of the cases investigated. Most of the patients with STD were in the age range 20-39 years. Of the infected patients 49.3% had their infections from prostitutes. Nearly half the patients examined and found infected with STD were in the low-paid socioeconomic group; and 71.4% of them were single. The social and cultural factors related to these results were discussed in the report.
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During the period October 1976 to January 1978, 290 patients were examined for sexually transmitted diseases in three venereal clinics in Khartoum Providence. Clinical and laboratory findings showed that nongonococcal urethritis was the commonest STD in men (35.1%), with gonorrhoea the second commonest (25.9%). Most of the patients with STDs were aged between 20 and 30 years. Of the infected men, 49.3% had acquired their infections from prostitutes.
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Ivermectin efficacy and post-treatment reactions in asymmetric severe reactive ochodermatitis (sowda) were studied in 8 patients with sowda syndrome and 6 with mild generalized onchodermatitis in Sudan. Initial skin snips from 12 patients contained microfilariae (1-9 per mg skin). Patients were treated in hospital with a single oral dose of c. 150 micrograms/kg ivermectin (103-200 micrograms/kg) and monitored for frequency and severity of post-treatment reactions for 4 weeks. Serial samples of heparinized blood were collected over the first 24 h after treatment for determination of ivermectin pharmacokinetics. Skin snips from all patients on days 3 and 28 revealed no microfilariae. Post-treatment reactions were more common and severe in individuals with sowda; they consisted mainly of musculoskeletal pain, local swellings with pitting oedema, and lymph gland tenderness and enlargement. No relation was established between these reactions, the microfilarial infection intensity, or the plasma pharmacokinetic profiles. A single oral dose of ivermectin cleared the skin of microfilariae and led to improvement of symptoms and dermatological signs of sowda, but resulted in more marked reactions than in cases of generalized onchodermatitis.
A study to monitor ivermectin acceptability and post-treatment reactions during mass community distribution was carried out in eastern Sudan, where severe reactive onchodermatitis is prevalent. Of 1081 individuals eligible for treatment, 1076 (99.5%) accepted the ivermectin. Post-treatment reactions were monitored by self reporting, 5 d after a single dose of about 150 micrograms/kg (range 103-200 micrograms/kg); 230 persons reported adverse events (21.4%). No reaction was rated as severe. The most common problem was itching with cutaneous papular eruptions (16.2%). Local oedematous swelling was the second most common and the most slowly resolving complaint (5.4%), followed by musculoskeletal pain. There was a high acceptance rate of the treatment and remarkable tolerance of the post-treatment effects, probably due to efforts made to prepare the community to expect reactions to ivermectin, widespread awareness of the beneficial effects of treatment by villagers who had participated in clinical trials previously, and the encouragement we gave to the population to become involved in improvement of their health care services. Single doses of ivermectin resulted in good clinical responses and created much goodwill among villagers. Improvements in physical fitness, ability to work, and freedom from musculoskeletal pain were reported at the 3 months' follow-up. We recommend that, during mass distribution of ivermectin, community involvement in planning overall health improvement should be included, since the treatment initiates the process well. In areas where sowda syndrome is prevalent, medical surveillance for 3 d or more should be considered.