Comparative bioavailability study of a generic sustained release diclofenac sodium tablet.

The bioavailability of a generic diclofenac sodium sustained release tablet preparation (Zolterol, SR) was compared with the innovator product, Voltaren, SR. Twelve healthy adult male volunteers participated in the study, which was conducted according to a randomized, two-way crossover design with a wash out period of one week. The bioavailability of diclofenac was compared using the parameters area under the plasma concentration-time curve (AUC(0-infinity)), peak plasma concentration (Cmax) and time to reach peak plasma concentration (Tmax). No statistically significant difference was observed for both logarithmically transformed AUC(0-infinity), Cmax values and Tmax value of the two preparations.

Scalp and cranial bone metastasis of endometrial carcinoma: a case report and literature review.

OBJECTIVE: The aim of this study is to report a rare case of scalp and cranial bone metastasis of endometrial carcinoma and review the literature. METHOD: We report a 45-year-old multiparous woman with FIGO Stage 1A Grade II endometrial adenocarcinoma who presented 3 years following total abdominal hysterectomy and bilateral salpingo-oophorectomy with scalp and cranial bone metastasis. Similar cases in the literature are reviewed. RESULTS: The patient metastatic workup revealed local, distant, scalp, and cranial bone metastasis. She died within 6 months. The poor prognosis is similar to that of six other cases reviewed. CONCLUSION: Scalp and cranial bone metastasis following endometrial carcinoma is extremely rare. It is a reflection of a widely disseminated disease and poor prognosis. However, single bone metastasis has a better postmetastatic survival with the help of local radiotherapy than scalp and multiple bone metastasis.

Spinal aspergillosis in nonimmunocompromised host mimicking Pott's paraplegia.

The aim of this report is to highlight the less-known aspergillus spondylitis (AS) that may completely mimic Pott's paraplegia, leading to occasional but expensive diagnostic error, as the chemotherapeutic management of the two is different. A case of a patient with the diagnosis of Pott's paraplegia who turned out to have aspergillus spondylitis is described. Issues and difficulties regarding the differentiation between these two forms of spine infection and their therapeutic implications are discussed. We conclude that differential diagnosis of spinal tuberculosis (TB) should include aspergillus spondylitis, as cure of spinal aspergillosis, especially in early stages, is possible with surgery and/or antifungal agents, and morbidity and mortality are high in neglected cases.

Low rate of shunt revision in tumoural obstructive hydrocephalus.

The authors calculated the shunt revision rate for 77 consecutive patients with tumoural obstructive hydrocephalus. At a mean follow up of 23.7 months, the annual revision rate was 0.06 which is significantly lower than the annual revision rate of 0.39 for other hydrocephalic patients treated during the same period. Shunted patients who had total excision of their lesions had a significantly lower revision rate than patients who had a partial excision or a biopsy. It is therefore, suggested that cases with tumoural obstructive hydrocephalus may represent a subset of hydrocephalic patients who are associated with a relatively low risk of shunt complications. The observation has to be addressed when the role of endoscopic third ventriculostomy in these patients is being considered.

Subacute sclerosing panencephalitis presenting as acute disseminated encephalomyelitis: a case report.

Subacute sclerosing panencephalitis is characterized by the insidious onset of diffuse cerebral dysfunction associated later with myoclonus and typical electroencephalographic changes. The disease progresses relentlessly to coma and death within 2 years. We report a case of acute onset and rapid course associated with atypical CSF, EEG and MRI features simulating acute disseminated encephalomyelitis. Brief review of relevant literature is presented.

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. The lesions were located as follows: 15 at the convexity, seven interhemispheric, four central, three basal, and one cerebellar. Nineteen patients (63%) underwent microsurgical excision, which was complete in 16 and incomplete in three. There were no postoperative deaths. Fifteen patients had no additional postoperative neurological deficit, while four patients sustained neurological deterioration, which was severe one. Two patients refused surgical treatment and the risk of surgery was considered too high in nine patients. Our result suggest that the local neurosurgical management standard of selected AVMs is quite satisfactory. However, for a more comprehensive therapeutic approach to these difficult lesions, national expertise in other therapeutic modalities, such embolization techiques and radiosurgery, is urgently needed.

Survival in malignant astrocytoma at King Khalid University Hospital.

Malignant astrocytoma (Kernohan grade III and IV) still has one of the worst outcomes of all malignant tumors. To determine factors affecting the survival of patients with malignant astrocytoma in Saudi Arabia, a retrospective study of 76 cases that were treated at King Khalid University Hospital over one decade was carried out. Kaplan-Meier survival diagrams were constructed for each prognostic factor. Twenty-eight percent of cases survived two years. A significantly better survival rate was found in females, patients /=70 at presentation, patients who had craniotomy and excision and patients who had radiotherapy. It is suggested that to improve the outcome of patients with malignant astrocytoma, aggressive surgical excision with radiotherapy (and possibly chemotherapy) is required.

Multiple brain abscesses at King Khalid University Hospital.

The authors reviewed six cases of multiple brain abscesses that were treated at King Khalid University Hospital (KKUH) over an eight year period. This represented 22% of the total brain abscesses treated during the same period. The series is unusual in that the infective pathogens were fungi (Fonsecaea pedrosoi) in two patients (33%) and an aerobic actinomycete (Nocardia asteroides) in one patient (16%). Two patients treated elsewhere with antibiotics empirically for one month died at three and 28 days following admission. The poor outcome was probably related t the delay in obtaining a microbiological diagnosis and commencing the appropriate antimicrobial therapy. The importance of early identification of the pathogen in patients with multiple brain abscesses is stressed.

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. Thirty percent of cases were less than 20 years of age while 71% were more than 60 years of age. The brain to spinal cord tumor ratio in our unit was 12.3:1. The ratio of Schwannoma to meningioma was 1.6:1. Metastatic carcinoma accounted for a mere 13% of cases and only 35% of tumors were located in the thoracic spine. Intramedullary tumors accounted for 17% of cases. An overall 63% of cases improved postoperatively while 37% remained unchanged.

Unique complications of cerebrospinal fluid shunts in children--a report of two cases.

The authors report on two cases with unusual CSF shunt complications. The first case had a peritoneal catheter which migrated down a patent processus vaginalis into a hydrocoele. The second case had an atrial catheter which perforated the atrial wall and came to lie in the pericardium causing an effusion. Clinicians should be aware of the frequent and occasionally bizarre complications of CSF shunting.

Surgical management of Chiari malformation and syringomyelia: Experience in 14 cases.

Our experience with 14 patients afflicted with symptomatic Chiari malformation and syringomyelia, who were treated at King Khalid University Hospital between 1983 and 1990, is analyzed with reference to presentation, management, operative findings, and outcome. Patients with associated myelomeningocele, tethered cord, and spinal cord tumors were excluded from this series. The wide variations in natural history and clinical findings are emphasized. Neuroradiological studies included plain roentgenograms, myelograms, metrizamide-enhanced computed tomograms, and more recently magnetic resonance imaging scans. Posterior fossa decompression was the standard operation; other surgical procedures included syringosubarachnoid shunt, ventriculoperitoneal shunt, transoral odontoid resection, and terminal ventriculostomy. Four patients experienced definite improvement following surgery; the condition in seven was unchanged, and three suffered worsening of the disorder despite operation.

Congenital nasopharyngeal teratoma in newborn: case report and review of literature.

A rare case of nasopharyngeal teratoma (epignathus) is described in a newborn female, presenting with life threatening respiratory embarrassment. Complete excision was achieved. The management and differential diagnosis are discussed, accompanied by a review of the literature.