This study confirms significantly higher levels of plasma homocysteine in AAA patients but lower levels of B12. Use of supplemental vitamins that should lower plasma homocysteine may modify vascular disease progression. Clinical trials in this direction are warranted.

diagnosis of Crohn disease was made, and she was treated empirically with courses of steroids, without significant improvement. In January 2007, she presented with small-bowel obstruction. An urgent laparotomy for resection of a 7-cm ileal tumor was performed. Histopathologic examination revealed a proliferation of large, atypical cells with plump pleomorphic nuclei [ Figure 1(a)]; immunohistochemistry analysis showed that the malignant cells were positive for vimentin, CD68, CD4, and lysozyme [Figure 1(b)]; variably positive for CD45 and S-100; but negative for CD2, CD3, CD5, CD7, CD8, CD20, CD21, CD23, CD23, CD30, CD43, CD1a, BCL-2, BCL-6, CK8-18, and keratin AE 1/3. In addition, no evidence of clonality of B or T cells was found on molecular analysis. The overall features were consistent with hs. The resection margins of the small bowel and two associated lymph nodes were free of malignancy. Computed tomography (ct) imaging showed paraesophageal, retroperitoneal, and retrocrural lymphadenopathies. Bone marrow aspiration and biopsy were normal.The patient was treated with 6 cycles of chemotherapy. The chop chemotherapy regimen (cyclophosphamide 750 mg/m 2 , doxorubicin 50 mg/m 2 , vincristine 1.4 mg/m 2 , prednisone 100 mg) was given every 21 days, although the first cycle of the regimen was replaced with inpatient administration of epoch (etoposide 50 mg/m 2 daily for 4 days, prednisone 60 mg/m 2 daily for 5 days, vincristine 0.4 mg/m 2 daily for 4 days, cyclophosphamide 750 mg/m 2 , doxorubicin 10 mg/m 2 daily for 4 days) to watch for potential chemotherapy-induced bowel perforation. Post-treatment evaluation demonstrated no evidence of disease on history and physical examination, and ct imaging showed complete remission. Posttreatment surveillance was instituted.One year later, the patient started to experience intermittent fever, night sweats, and marked fatigue. Physical examination revealed cervical and supraclavicular lymphadenopathies, no abnormality on cardiorespiratory examination, and no ABSTRACTHistiocytic sarcoma is diagnosed according to established criteria. However, treatment is controversial: although lymphoma chemotherapy regimens are often used, their impact on the natural history of the disease is unclear. Here, we report a disease-free survival of 2 years after autologous stem-cell transplantation in a patient with relapsed histiocytic sarcoma.

No study has been published yet in the Arab world regarding response and outcome of imatinib in patients with chronic myeloid leukemia (CML). This study evaluated a total of 122 patients with CML treated with imatinib between 2001 and 2012. Survival, hematologic, cytogenetic and molecular responses and adverse events were assessed. The 5-year overall survival (OS), event free survival (EFS) and progression-free survival (PFS) rates were: 95.4 ± 2.3%, 81.4 ± 4.6% and 90.8 ± 3.2%, respectively. Significant differences in OS (p = 0.001), EFS (p = 0.001) and PFS (p = 0.001) were noted when patients were stratified by cytogenetic response. Survival by Sokal risk groups was not significant (p = 0.293). Complete hematologic response was achieved in 94 patients (93.1%), cytogenetic response in 84 (83.2%), major molecular response in 62 (61.4%) and complete molecular response in 34 (33.7%). This article presents the first evidence on the effectiveness of imatinib in patients with CML from Saudi Arabia and highlights similarities and differences in response patterns in published studies.

Haematological and vascular features of dengue virus infection are common and vary from tiny skin haemorrhages to significant bleeding such as epistaxis, gastrointestinal bleeding and hematuria. Spontaneous splenic rupture has also been reported as an atypical manifestation in dengue fever. We report a case of splenic infarction in a 35-year-old man who presented with fever, vomiting, diffuse abdominal pain and distention, diarrhoea, hematuria, headache, back pain, hypotension, pleural effusion and ascites. Laboratory evaluation confirmed the diagnosis of dengue hemorrhagic fever, and abdominal imaging revealed splenic infarction. He required intensive care, responded well to inotropic support and remarkably improved.

Background Cancer is a well-known risk factor of preventable thromboembolic disease. This study aims to provide guidance on the prevention and management of cancer-associated thrombosis (CT) that tailors prophylactic and therapeutic options for medical and surgical oncology patients presenting to health care settings in Saudi Arabia. Methods The present consensus was developed in concordance with the modified Delphi-based approach, which incorporates a face-to-face meeting between two voting rounds to gain experts' feedback on the proposed statements. All experts were either oncologists, hematologists, or hemato-oncologist with an active clinical and research profile in hemato-oncology. Results The experts highlighted that the comparatively high incidence of inherited thrombophilia among the Saudi population may account for a higher CT burden in the Kingdom than in other parts of the world. However, due to the lack of literature that assesses CT in Saudi Arabia, primary venous thromboembolism prophylaxis should be tailored according to a valid risk assessment of cancer patients and should be implemented in routine practice. For hospitalized medical oncology patients, the experts agreed that prophylaxis with low-molecular-weight heparin (LMWH) should be offered, regardless of the presence of acute illness. For ambulatory medical oncology patients, LMWH or direct oral anticoagulants (DOACs) prophylaxis should be offered for high-risk patients. Concerning surgical patients, they agreed that all oncology patients undergoing surgery should be offered thromboprophylaxis. In terms of secondary prophylaxis, the experts recommended continuing a prophylactic dose of anticoagulant (LMWH or DOAC), for an appropriate period depending on the cancer type and stage. Finally, they also provided a set of statements on management of CT in Saudi Arabia. Conclusion The present modified Delphi-based study combined the best available evidence and clinical experience with the current health care policies and settings in Saudi Arabia to build a consensus statement on the epidemiology, prevention, and management of CT.