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Alkushi A.,King Fahad National Guard Hospital | Kobel M.,University of Calgary | Kobel M.,Genetic Pathology Evaluation Center | Kalloger S.E.,University of British Columbia | Gilks C.B.,University of British Columbia
International Journal of Gynecological Pathology | Year: 2010

High-grade endometrial carcinomas are a heterogeneous group of tumors and include grade 3 endometrioid (EC-3), serous (SC), and clear cell carcinomas (CCC). There are conflicting data about the prognosis of these subtypes of high-grade endometrial carcinoma; this may be a result of lack of reproducibility in classifying tumor cell type. The purpose of this study was to examine differences in immunophenotype and outcome in a series of high-grade endometrial carcinomas, focusing on the comparison of EC-3 versus SC. We selected 180 endometrial carcinomas of SC, EC, or CCC type. No mixed carcinomas were included in the study. We chose the following immunohistochemical markers, estrogen receptor (ER), insulin-like growth factor 2 mRNA-binding protein 3 (IMP3), p16, p53, progesterone receptor (PR), and phosphatase and tensin homolog (PTEN) as being significantly differentially expressed in endometrial carcinoma subtypes. The tumors were stratified into 4 groups on the basis of their cell type and grade: EC grade 1 or 2, EC-3, SC, and CCC. Univariate survival analysis revealed significant differences in outcome between the 4 groups (P<0.0001), with significantly longer disease-specific survival for grade 1 or 2 EC versus EC-3 (P=0.0001), and EC-3 versus SC (P=0.0003). p16, PTEN, and IMP3 expression was observed more frequently in SC compared with EC-3 (P<0.0001, P=0.021, and P=0.031, respectively). These 3 markers showed the highest sensitivity and specificity in distinguishing between EC-3 and SC, with receiver operating characteristics area under the curve of 0.85, 0.69, and 0.71, respectively. ER and p53 approached but did not reach significance for differential expression in EC-3 versus SC (P=0.055 and P=0.068, respectively). A combination of p16 and PTEN predicts EC-3 versus SC with a sensitivity of 90.0% and specificity of 96.8%. p16 and PTEN can aid in distinguishing between EC-3 and SC of the endometrium, and are superior to ER, PR, and p53 for this purpose. EC-3 carcinomas have a significantly better prognosis than SC carcinomas of the endometrium. © 2010 International Society of Gynecological Pathologists.

Al-Meshal O.,King Fahad National Guard Hospital | Gilbert A.,Institute Of La Main
BioMed Research International | Year: 2013

There are multiple nerve branches supplying the triceps. Traditionally, the nerve to the long head of triceps is utilized for nerve transfer to neurotize the deltoid muscle in patients with brachial plexus injuries. However, no anatomical studies were done to investigate which triceps nerve would be preferred for nerve transfer. This anatomical study was carried out to describe the innervation pattern of the triceps muscle to investigate the preferred triceps nerve for nerve transfer. Twenty-five cadaveric arms were dissected. The long head of the triceps received a single branch in 23 cases (92%) and double branches in 2 cases (8%) only. The medial head had a single branch in 22 cases (88%) and double branches in 3 cases (12%). The lateral head was the most bulky one and received more than one branch in all cases (100%), ranging from 2 to 5 branches. The transfer of the most proximal branch to the lateral head of the triceps seems to be the most preferred choice for deltoid muscle innervation. © 2013 Obaid Al-Meshal and Alain Gilbert.

AlGhamdi K.M.,King Saud University | Almohedib M.A.,King Fahad National Guard Hospital
International Journal of Dermatology | Year: 2011

Background As the use of the Internet increases, it is important to gain insight into how it is used by patients to obtain health-related information. Objectives We aimed to explore the attitudes and practices of dermatology outpatients regarding their use of the Internet to find health information. We also aimed to investigate the consequences of this Internet use on the patient-doctor relationship. Methods A self-administered questionnaire on Internet use was given to adult dermatology outpatients attending the Dermatology Department at King Saud University, Riyadh, Saudi Arabia, from January to June 2008. Results A total of 86% (432/500) of distributed questionnaires were returned. The mean age of respondents was 29.7±10.0years. Of the respondents who answered the relevant items, 42% (185/431) were females, 87% (376/432) were Internet users, and 47% (190/404) stated that they had accessed the Internet to obtain general medical information. Younger women educated to college level and with higher incomes tended to search for online health-related information more often than other groups. More than 93% (343/367) of respondents reported that they relied on their doctors as their primary source of information, but 69% (277/401) indicated that online medical information was beneficial, and almost 8% (30/399) stated that they would always trust data obtained from the Internet. Conclusions A significant proportion of patients use the Internet to search for medical information. This has a positive effect on the patients' skin diseases and on their relationships with their doctors. Therefore, doctors should be more aware of the health-related information available online and should guide patients to reliable websites. © 2011 The International Society of Dermatology.

Alharbi F.F.,King Fahad National Guard Hospital | El-Guebaly N.,University of Calgary
Addictive Disorders and their Treatment | Year: 2013

Objectives: Disulfiram (DSF) treatment remains a viable option as a treatment for alcohol dependence. There have been concerns about its safety, which are often used as a reason for withdrawing the treatment or as an argument against starting it. How safe is the current prescription of DSF? This paper aims to provide an update of DSF's safety-related research. Method: A systematic review of the recent literature was drawn from a comprehensive Medline (2000 to 2012) search. Case reports and clinical trials using DSF for the treatment of alcohol and/or cocaine use and/or dependence were reviewed. Result: Within the specified period, there have been 30 case reports and 8 clinical trials regarding DSF's side effects. One was a longer trial of DSF spanning >50 weeks. The case reports were related to neurological, hepatic, cardiac, dermatological, psychiatric adverse events, neuroimaging findings, and drug-drug interaction. Because of exclusion criteria, adverse events in DSF randomized double-blind clinical trials seem to be less serious and less frequent than adverse events reported postmarketing. Conclusions: With the safety recommendations in place, we consider the administration of DSF to be safe practice and within an acceptable risk profile. © 2012 by Lippincott Williams & Wilkins.

Jahangiri F.R.,King Fahad National Guard Hospital
Neurodiagnostic Journal | Year: 2013

Previously, intraoperative neurophysiological monitoring was not used routinely during tibial osteotomies. In an attempt to improve the post-operative outcomes and reduce known neurologic complications, we used discrete multimodality recording and stimulation models to identify areas of motor and sensory function in eighteen (18) pediatric patients presenting with Tibia Vara (Blount's Disease). By using both posterior tibial and peroneal nerves somatosensory evoked potentials (SSEPs) with transcranial electrical motor evoked potentials (TCeMEPs) precise status of sensory and motor pathways was possible during surgical correction. Similarly, spontaneous electromyography (s-EMG) and triggered electromyography (t-EMG) were used to more accurately localize nerve irritation. Concerns during tibial and fibular osteotomies included ipsilateral lower limb motor and sensory function, especially peroneal nerve injuries due to the location of the osteotomy at the fibular neck. Surgical interventions consisting of additional fibular resection were made during the index procedures for four patients because of real-time monitoring changes noted as the peroneal nerve was entrapped in three patients at the osteotomy site. In fourth patient, the tourniquet pressure was the cause for loss of ipsilateral SSEPs and TCeMEPs. After appropriate surgical intervention, monitoring parameters began to normalize and postoperatively the patients presented with no neurologic deficit. In this study, the application of multimodality recording and stimulation models were utilized including posterior tibial nerve and peroneal nerve SSEP with lumbar potential (LP) identification to compare with contralateral limb recordings. In addition, by using spontaneous and triggered EMG and TCeMEP, we were able to perform monitoring with a high level of confidence throughout surgery. © ASET, Missouri.

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