MRS in the differential diagnosis of tremors

By the time Parkinson 's disease [PD] symptoms appear, the substantia nigra [SN] already has lost about 60% of dopaminergic neurons. So, with the advent of neuroprotective agents that could slow or prevent disease progression, it reinforces the need to define at-risk patients so that such a disease-modifying therapy could be initiated before the development of clinical dysfunction. However, there is a real clinical diagnostic problem in the differentiation between PD and essential tremor [ET] in the early stages of both disorders. To investigate the use of proton magnetic resonance spectroscopy [[1]H-MRS] as an objective diagnostic index in the differential diagnosis of PD from ET in the early stages of both disorders. This was a cross sectional study in which 20 patients with PD meeting the United Kingdom Brain Bank criteria for the diagnosis of idiopathic PD were recruited. They were Hoen and Yahr stage I to II. In addition, 20 patients with ET meeting the diagnostic criteria were also recruited. All patients underwent a routine MRI brain to exclude underlying pathology. Brain [1]H MRS was performed. The spectroscopic volume of interest was placed in the putamen, the temporal, and the cerebellar cortices. The metabolite ratios NAA/Cr NAA/Cho and Cho/Cr were determined. It was found that in comparison to the ET group, the PD group had significantly lower NAA/Cho ratio and higher Cho/Cr ratio in the putamen, and lower NAA/Cr and NAA/Cho ratios in the temporal region. On the other hand, ET group had significantly lower NAA/Cr and NAA/Cho ratios in the cerebellum than the PD group. The current study protocol that includes muti-regional [1]H-MRS assessment of the putamen, temperoparietal, and cerebellar cortices proved to be of considerable value in the differential diagnosis between PD and ET in the early stages of both disorders

Post hemorrhoidectomy pain. A randomized controlled trial

To compare the effect of metronidazole on post conventional hemorrhoidectomy pain in patients with third and fourth degree hemorrhoids. Two hundred consecutive patients admitted in King Fahad Hospital, Hofuf, Saudi Arabia between June 2002 and May 2004 for surgical treatment of 3rd and 4th degree hemorrhoids were randomly assigned into 2 groups. In Group 1 [100 patients] pre and postoperative metronidazole was used and in Group 2 [100 patients] no medications were given. All patients received castor oil from 2 days before surgery and lactulose after surgery for 2 weeks. Patients were discharged home when free of pain. Patients in group 1 had significantly less pain than those in the second group. Hospital stay and time to first bowel motion were not significantly different between both groups and, early and late complications appear similar. Return to normal activity was significantly shorter in the metronidazole group. Prophylactic metronidazole in Milligan-Morgan hemorrhoidectomy is associated with less pain and earlier return to normal activity

role of fine needle aspiration cytology and imprint cytology in cervical lymphadenopathy

To determine the diagnostic accuracy of cervical lymphadenopathy by fine needle aspiration [FNAC] and imprint cytology [IC]. This study included 94 patients with cervical lymphadenopathy. This study was carried out in the Departments of General Surgery and Pathology, King Fahad Hospital, Hofuf, Kingdom of Saudi Arabia, from June 2001 through to July 2002. They were subjected to clinical examination and FNAC of one of the enlarged lymph nodes. This was followed by IC and histological examination of this lymph node after its excision. Clinical examination was correct in 78% of the cases. The overall accuracy of fine needle aspiration was 93%. It was accurate on all cases of reactive hyperplasia, 93% of tuberculosis lymphadenitis, 90% in Hodgkin's lymphoma, 86% in non-Hodgkin's lymphoma, and 91% of metastasis lymphadenopathy. On the other hand, the overall accuracy of IC was higher than that of fine needle aspiration, being 97%. It diagnosed all cases of reactive hyperplasia and non-Hodgkin's lymphoma, 97% in tuberculosis lymphadenitis, 90% in Hodgkin's lymphoma and 95% in metastasis lymphadenopathy. These techniques proved to be reliable, rapid, and inexpensive procedures in diagnosis of lymphadenopathy. They can differentiate well between inflammatory and neoplastic lesions, in cases of lymphoma, cytological diagnosis should be followed by histological diagnosis for accurate classification and grading