jugular foramen: a review of old and new imaging techniques and diagnoses

The imaging anatomy of the jugular foramen [JF] has been described. This is followed by an account of the various historical techniques used for diagnostic visualization. It is obvious that imaging interest has swung almost entirely to newer modalities as a result of dissatisfaction with plain films and conventional tomograms. In many parts of the world, places where no imaging facilities are available, a base view 50-70 degrees short of full extension, and a lateral oblique view are still of value in diagnosing a large foramen or fossa. Demonstration of the exact anatomic details of the bone is not possible without high resolution computed tomography [HRCT]. Conventional pleuridirectional tomography has retreated but remained complementary to computed tomography and a valuable tool in its absence. Computed tomography [CT] and magnetic resonance [MR] provide more information on intracranial or extracranial extensions of tumours as well as on the involvement of adjacent soft tissues. Four-vessel arteriography and jugular venography add important diagnostic characterization. The diagnostic criteria for each of the pathological conditions and the size of the lesion has been described with the justification for the use of a particular techniques. In nontumoral conditions, CT demonstrates smooth intact margin of the JF, except in cerebral venous thrombosis where phase contrast MR venography is the imaging modality of choice. In most tumoral lesions CT shows areas of infiltrative bone involvement, most schwannomas and meningiomas cause smooth enlargement rather than erosion. The multiplanner nature of MR imaging gives better definition and extent of soft tissues lesions, as well as more specific diagnostic criteria. Most of the tumors show low to intermediate signal intensity on T1- weighted images, and intermediate to high intensity on T2-weighted images, and enhance strongly. Each lesion requires a combination of available modalities to reach the specific diagnosis, sometimes the use of three dimentional CT is indicated, particularly in pre- and postsurgical intervention

Comparison of an integrated problem-based learning curriculum with the traditional discipline-based curriculum in KSA

To compare the integrated problem-based learning [PBL] curriculum of the third year medical students of KSU at the Al-Qaseem campus with the traditional discipline-based teaching curriculum of students of Riyadh campus. A comparative cross-sectional study. Al-Qaseem and campuses of King Saud University [KSU]. A structured questionnaire was used for comparing the students of third year at both campuses of KSU. The student's learning behaviours and their liking for teaching methodologies was evaluated from March to June 2003. There were 138 3rd year students of Riyadh campus [59 females and 79 males] and 65, of Al- Qaseem campus [17 females and 48 males] [N=203]. Fifty-eight percent of students' at Al-Qaseem campus went to the library two or more times compared to 3.4% of the Riyadh campus [P =0.000], 18.5% of Al-Qaseem campus used Journals [P =0.000], and 86% did self-learning [P =0.000], which was much higher than the students' at Riyadh campus. Almost 75% students at Al-Qaseem campus were satisfied with their system of education compared to 20% at Riyadh campus [P =0.000]. Sixty-nine percent students at Al-Qaseem campus answered problem-solving questions correctly versus 7.25% of the students at Riyadh campus. The students of both campuses liked group teaching almost equally and thought it makes them remember better. The Al-Qaseem campus students liked PBL, clinical skills lab, tutorials, and also lectures delivered at the college. PBL improved the students' usage of learning resources, problem-solving abilities and they were satisfied with their learning and the curriculum

Ultrasound guided fine needle aspiration using 25G needle as a new technique for a wide range of pathological conditions

This study is to report on the use of 25 gauge [G] needle in ultrasound [US] guided fine needle aspiration [FNA], as a new technique for a wide range of pathological conditions, and to assess the yield of positive tissue material and the complications compared to those reported in the literature using larger needles. One hundred and seventy-two patients presented consecutively at King Saud University Teaching Hospitals, Kingdom of Saudi Arabia, during the period 2000 to 2002, with various pathological conditions, underwent US guided FNA using 25G needle. The adequacy of the tissue obtained, and the pathological outcome were tabulated. The patients were discharged in the same day and followed for 4-6 weeks for complications. Adequate tissue was obtained from 165 [96%] patients. Seven [4.1%] patients had to be examined twice, to obtain a sufficient sample. The 172 patients also included 14 patients [8.1%] who had repeated procedure on the request of the clinician, who needed confirmation of the pathological diagnosis. Adequate sampling was obtained in the first attempt in 89%, in liver problems, and in other regions, and 86.8% in lung problems. The percentages of diagnostic categories revealed by the cytological analysis are similar to those obtained by other larger fine needles. No complications have been encountered. The technique can safely be repeated if the amount is inadequate or diagnosis is inconclusive, to reach 100% correct sampling. The results of positive findings are comparable to other studies using larger needles. The use of 25G needle is recommended for use under ultrasound guidance

Cigarette smoking behavior among male secondary school students in the central region of Saudi Arabia

This study was conducted to examine the smoking habits among male secondary school students in Al-Qassim, Kingdom of Saudi Arabia [KSA] and to assess their knowledge and attitudes towards smoking. This cross-sectional study was conducted in Al-Qassim region, KSA during March 2003. Randomly selected was 14 out of 110 government male secondary schools. In the sample section, care was taken to represent urban and rural communities. In urban areas, 8 schools with the largest number of students were selected. This is in addition to 3 schools, which were the only schools with special education on Islamic, Commercial and Technical programs. In the rural areas the 3 most distant schools were included in the sample. Data were obtained through self-administered questionnaires that contained questions on personal background, smoking behavior, knowledge and attitude towards cigarette smoking. A total of 2203 students responded to the questionnaires with 83% response rate. Of the studied group, 606 [29.8%] were current smokers and among these 83.7% started smoking at the age of 15 years or less. Technical and commercial secondary school students had higher prevalence of the habit of smoking than those in general and Islamic secondary schools. It was found that the more pocket money received by the students, the higher was the prevalence of smoking. The most common reason given for cigarette smoking behavior [CSB] was the influence of friends [63.5%]. Family factor, especially the brother's smoking habit [24.8%] was also important. Most of the students knew that smoking is harmful to their own health [89.3%], and to others [73.9%]. The association between smoking and lung cancer was 84.3%, 80.9% for chest disease and 78.2% for heart disease, while the relation to other diseases was less known. We conclude that onset of smoking in the young is alarming. This is of immense importance in formulating health education strategies, which should be directed towards pupils, teachers and parents. The religious aspect should also be an integral part of such programs

Unnecessary x-rays: occurrence, disadvantages and side effects

Unnecessary use of radiodiagnostic tests is a cause for worldwide concern. As much as 20-30% of x-rays in Britain, Cananda and America were proved unnecessary. These unnecessary x-rays are assumed to cause 250 cancer deaths yearly in Britain and cost millions of pounds. All rich nations have embarked on restricting non-selective use of radiologic services. In Saudi Arabia there was no study for the ordering behavior of physicians for radiodiagnostic tests. The free access to primary and tertiary health care and the demanding nature of our patients can lead to the indiscriminate use of radiology services. This article addresses the problem of overutilization of x-ray tests and emphasizes the need for a national policy to reduce the biologic hazards and initiate a cost effective use of radiologic services. According to our own estimate a few hundred million Riyals could be saved by stopping unnecessary x-ray examinations