Progressive supranuclear palsy: New brain stem measurement and its clinical correlations

Objective: to detect the value of mid-sagittal MRI measurements of the midbrain and pons in the diagnosis of Progressive Supranuclear Palsy [PSP] and to differentiate it from mimics [Parkinson Disease [PD] and Multiple-System Atrophy of the Parkinson Type [MSA-P]], and to what extend these radiological measurements correlate with the clinical aspects of PSP

Methods: MRI of 13 patients with PSP, 25 patients with PD, and 10 patients with MSA-P, as well as 20 age-matched controls were prospectively studied. The areas of the midbrain tegmentum and the pons were measured on mid-sagittal MRI using the display tools. The ratio of the area of the midbrain to the area of the pons was also evaluated in all subjects. Patients were also evaluated clinically using Hoehn and Yahr Scale, UPDRS and MMSE scale in addition to full general, neurological assessment and routine laboratory investigations

Results: the average midbrain area of the patients with PSP [57 mm[2]] was significantly smaller than that of the patients with PD [101 mm[2]] and MSA-P [97.9 mm[2]] and that of the age-matched control group [116.9 mm[2]]. There was no overlap between patients with PSP and patients with PD or normal control subjects regarding midbrain area values. However, patients with MSA-P showed some overlap of the values of individual areas with values of individual areas with values from patients with PSP. The ratio of the area of the midbrain to the area of pons in patients with PSP [0.123] was significantly smaller than that in those with PD [0.207] and MSA-P [0.265] and in normal control subjects [0.235]. Also, use of the ratios allowed differentiation between PSP groups and the MSA-P group. Good significant correlation was observed between various radiological measurements studied and disease duration, staging and severity

Conclusion: the mid-sagittal MRI measurements of the midbrain area can differentiate between the PSP from PD, MSA-P and normal aging and these radiological measurements correlated well with the clinical aspects of the syndrome of PSP

How to proceed with patients with suspected blunt abdominal trauma and negative screening US scans

To assess outcome of patients with blunt abdominal trauma and negative screening ultrasonographic [US] scans and consequently propose a protocol for their diagnosis. A retrospective study of 460 patients with possible blunt abdominal trauma, who had negative screening US, done at the Radiology Department, in King Fahd Military Medical Complex, Kingdom of Saudi Arabia [KSA], was performed. In these patients, outcome was determined by means of retrospective review of all radiological, medical, and surgical reports. Proportions were statistically compared by means of the Pearson chi[2] and Fisher exact tests. Among the 460 patients with negative findings at screening US, 95% [n=437] had true-negative findings. Among the 437 patients with true-negative findings, 92.9% [n=406] required no additional tests and 7.1% [n=31] underwent other procedures for suspicion of abdominal trauma, which confirmed US findings. 23 patients had false-negative US findings for abdominal injury. From the missed injuries, 29 were nonsurgical [those that were treated successfully without intervention] and nine were surgical [required surgical intervention]. Cumulatively, 38 injuries were missed. The common injuries included injuries in the spleen [n=10], liver [n=9], kidney [n=7] and retroperitoneal hematoma [n=6]. The missed injuries that were identified within the first 12 hours formed 63.2% of the total injuries, including 77.8% of the surgical ones. The combination of negative US findings and negative clinical observation excludes abdominal injury in patients who are admitted and observed for at least 12-24 hours, with computed tomography [CT] indicated in cases with mismatch of clinical and negative US data

Cephalometric analysis in patients with obstructive sleep apnea syndrome

In this study, the distances and areas in cephalometry were measured before and after surgery in order to evaluate the preoperative predictability and usefulness of uvulopalatopharyngoplasty and/or midline laser glossectomy [MLG] for the preoperative assessment and evaluation of the surgical treatment. Egyptian adult patients with disturbed respiration in sleep observed at Snoring Center in Kasr El- Aini Hospital and Saudi patients with the same problem observed at Saudi German Hospital were tested. Cephalometry revealed morphological abnormalities in the skull and the measurements of soft tissue in oropharynx provided useful anatomical data to the space of the upper airway in each patient before operation. The areas of the soft palate, the whole tongue and the lower half of the tongue were significantly enlarged and the lengths of MPH, SPL and PNS-H were longer in the apnea group than in the snoring group. In MLG patients, an increase in the area of the oral and pharyngeal cavities and a decrease in the area of the upper half of the tongue were observed

Gadolinium as an alternative contrast agent for diagnostic procedure in patients with renal insufficiency

Gadolinium was used as a radiographic contrast agent in 17 diagnostic procedures in 17 patients with renal insufficiency [average serum creatinine of 3.72 +/- 1.8 mg/dl]. The dose of gadolinium ranged from 0.22 to 0.44 mmol/kg body weight. Seventeen diagnostic procedures, eight angiographic procedures [selective renal angiography in four patients, lower extremities angiography in two patients and coronary angiography in two patients], five venographic procedures [upper extremities in four patients and inferior venacavography for one patient] and four computed tomography scans [CT scan] were performed. It was concluded that gadopentate dimeglumine is a safe alternative radiographic contrast agent for diagnostic contrast procedures in patients with pre-existing renal insufficiency