Predictive models for difficult laryngoscopy and intubation. A clinical, radiologic and three-dimensional computer imaging study.

Purpose: To identify the variables most useful in predicting difficult laryngoscopy and intubation from various clinical, skeletal (lateral x-rays) and soft tissue (three-dimensional computed tomography imaging) measurements.

Methods: Twenty-four adult patients in whom an unanticipated difficult tracheal intubation was identified according to established criteria were evaluated. Further, a control group of 32 patients in whom tracheal intubation was easily accomplished was studied.

Moyamoya syndrome with unusual angiographic findings and protein C deficiency: review of the literature.

We describe the findings in a six-year-old female with typical clinical symptoms of Moyamoya phenomena, but with an unusual angiographic appearance. The vertebral artery showed segmented occlusion in the upper cervical region, with reconstitution via collateral circulation through muscular branches. The carotid circulation showed involvement of the external carotid artery (ECA) branches and marked narrowing of the internal carotid arteries (ICA) bilaterally, suggesting that this disease is systemic in nature.

Hepatobiliary scintigraphy in the diagnosis of choledochal cysts in children.

The objective is to present the usefulness of hepatobiliary scintigraphy in the investigation of children with suspected choledochal cysts through our experience in King Khalid University Hospital at King Saud University, Riyadh. Seven patients aged between I and 10 years (average 4.8 yrs) comprising six females and one male were investigated.

Acute disseminated encephalomyelitis: the importance of early magnetic resonance imaging.

The diagnosis of acute disseminated encephalomyelitis (ADEM) is frequently missed or delayed with consequent delay in instituting therapy in the crucial phase of the illness. The role of MRI in the diagnosis of ADEM is well established, however, the value of its early utilization of treatment on the outcome of patients has not been adequately stressed. Three patients with ADEM are described.

Arteriovenous malformations of the brain: Indications and outcome of microsurgical excision.

This study is based on a retrospective analysis of 30 consecutive patients with previously untreated cerebral arteriovenous malformations (AVMs), who were seen at King Khalid University Hospital between 1987 and 1994. There were 17 males and 13 females, ranging in age between nine and 52 years. Twenty patients presented with intracranial hemorrhage, while the remaining 10 complained of epilepsy.

Cerebro-vasculopathy and malignancy: catastrophic complications of radiotherapy for optic nerve glioma in a von Recklinghausen neurofibromatosis patient.

The authors report a unique case of a patient with intraorbital optic nerve glioma and von Recklinghausen neurofibromatosis who developed cerebro-vasculopathy and malignant transformation in the orbit 18 months after radiotherapy treatment. The case is an important reminder of the possibly increased susceptibility of von Recklinghausen neurofibromatosis patients to the complications of radiotherapy.

Renal sonographic patterns in Bartter's syndrome.

The renal sonographic findings in ten cases of Bartter s syndrome investigated at the King Khalid University Hospital, Riyadh, Saudi Arabia are described. There were various sonographic abnormalities other than those of hyperechoic pyramids as previously described. These were diffuse increased renal echogenicity and hyperechoic echogenicity in the kidneys with the exception of the pyramids.

Adrenoleukodystrophy: CT and MRI findings.

A case of adrenoleukodystrophy (ALD) with CT and MRI findings is described. The CT scan showed low densities in the white matter of the parietal and occipital lobes. No calcifications were seen.

Radiological appearances of dermoid tumours (with emphasis on fat fluid levels).

Nine cases of dermoid tumours, one in the chest and eight in the abdomen are reported with various radiological findings on plain films, ultrasound and computed tomographic (CT) scans. The various radiological appearances at ultrasound and CT are described. The incidence and frequency of fat-fluid interfaces on ultrasound and CT scans are highlighted.

Symmetrical lesions in the basal ganglia.

Bilateral and symmetrical non-space occupying lesions in the basal ganglia of 27 cases were studied. Nine cases had low attenuation lesions while the remaining 18 had high attenuation lesions due to bleeding or calcifications. The clinical presentations and final diagnosis were collated and related to these changes.

Experience with brain abscess in the central province of Saudi Arabia.

The characteristics of brain abscess in the Central Province of Saudi Arabia are outlined in this report which is a review of 22 consecutive cases that were treated at King Khalid University Hospital between 1985-1991. The incidence of brain abscess in Saudi Arabia is calculated to be 3.6 cases/500,000 population/year which is twice as high as the incidence reported from the West.

Dysgenesis of the corpus callosum: computed tomographic changes.

The CT findings in 32 cases of DCC are presented classifying them into three groups: Type I: Anatomical changes primarily due to callosal dysgenesis. Type II: Associated central nervous system anomalies. Type III: Incidental findings.

Role of radionuclide venography in the detection of proximal deep vein thrombosis: a prospective comparative study.

The role of radionuclide techniques in the investigation of thromboembolic disease has been re-evaluated. Forty-eight patients suspected of having embolic lung disease (PE) or deep venous thrombosis (DVT) were studied prospectively and investigated with radionuclide venography and ventilation/perfusion lung scintigraphy. Thirty-two also underwent contrast venography and peripheral 99Tcm-labelled red blood cell scintigraphy.

Experience with ductography (contrast mammography) at the King Khalid University Hospital, Riyadh, Saudi Arabia.

Twenty-six female who presented with nipple discharge between August 1989 and September 1991 underwent mammary ductography (contrast mammography) using water soluble contrast media. The ages ranged from 29 to 75 with a mean of 41.7 years.

Spinal tumors: Experience at King Khalid University Hospital.

This paper summarizes data on 30 consecutive spinal tumors treated at King Khalid University Hospital (KKUH) between 1984-1991. The male:female ratio was 2.75:1.

A comparative ultrasound and plain abdominal x-ray: Evaluation of non-classical clinical cases of appendicitis.

A prospective study of 109 patients with non-classical symptoms of appendicitis using the standard ultrasound (US) machine and plain abdominal x-rays demonstrated that US was superior to plain x-ray with a sensitivitiy, specificity and overall accuracy of 89%, 96% and 91%, respectively as compared with plain x-ray with 48%, 93% and 67% respectively. The negative appendectomy rate was 7%. In the alternative diagnosis, plain x-ray was superior to US due to the prevalence of intestinal diseases, ureteric calculi and basal pneumonia which were best shown in plain x-rays.

Osteopetrosis: brain ultrasound and computed tomography findings.

A case of osteopetrosis presenting with rare features of dysmorphism with proptosis due to hypoplasia of the orbits and the temporal bone is described. The case also had calcifications in the periventricular regions, the falx cerebri and the corpora colliculi. These features and sonographic findings of osteopetrosis have not been reported previously.

Fetal biophysical profile monitoring and perinatal outcome.

A prospective study of 109 high risk pregnancies on whom 279 fetal biophysical (FBP) examinations were performed showed positive and negative predictive values of 100% and 71.4%, respectively in the last FBP examination prior to delivery. The study confirmed other reports in the literature of a high correlation between normal examination and satisfactory perinatal outcome.

CT findings in paranasal aspergillosis.

Computed tomographic (CT) scan of eight cases of paranasal sinus aspergillosis were reviewed. Different CT patterns were observed such as areas of high densities, linear interlacing network of high density, radiolucent thin rim periphery to the masses, calcification, expansion of involved sinuses and bone erosion. Two cases of invasive type showed extension beyond the sinuses into the orbit and intracranially simulating a malignant tumour.

Ventriculitis and hydrocephalus caused by Candida albicans successfully treated by antimycotic therapy and cerebrospinal fluid shunting.

A unique case of Candida albicans ventriculitis and hydrocephalus in the absence of any evidence of systemic candidiasis or immunosuppression is reported. Initial treatment with CSF shunting and intravenous antimycotic therapy appeared to have eradicated the infection. Recurrence occurred 5 months after discharge and this was treated by intravenous and intrathecal antimycotic therapy in addition to removal of the shunt system, external ventricular drainage and then replacement of the shunt.

Brain atrophy in Werdnig-Hoffmann disease.

CT scan imaging of the brain was done in eight children with Werdnig-Hoffmann Disease. Seven of them showed generalized cerebral cortical atrophy and one had low attenuated, non-enhancing areas in the white matter involving both frontal lobes. These changes could be due to repeated episodes of hypoxic injury.

Gaseous distension of the gut during intravenous urography.

During intravenous urography, the changes in the gastrointestinal tract were assessed in a total of 101 patients within two subgroups: allergic and non-allergic, depending on the patient's reaction or non-reaction to the intravenously injected Conrary 420. The gastrointestinal changes were either nil (that is normal) or abnormal with definite increase in the total volume of gas in the abdomen. Increased gas was commoner (66%) among the non-allergic group as compared with 34% of the allergic group.