Abdel Wahab M. Ibrahim

Antiemetic efficacy of high-dose dexamethasone: randomized, double-blind, crossover study with high-dose metoclopramide in patients receiving cancer chemotherapy

A double-blind, randomized, crossover study was conducted to compare the efficacy and safety of high-dose dexamethasone and high-dose metoclopramide in the treatment of chemotherapy-induced nausea and vomiting. All entered patients had no prior chemotherapy and all received inpatient emetogenic chemotherapy mainly without cisplatin. Of the 40 evaluable patients, 23 (58%) had no vomiting with dexamethasone compared with only 11 (28%) receiving metoclopramide (P less than 0.025). Dexamethasone was found to have less adverse effect than metoclopramide on patients appetite and activity (P less than 0.025 and P less than 0.01, respectively). Twenty-one patients (53%) developed mild to severe somnolence with metoclopramide compared to only seven (18%) who experienced this adverse effect with dexamethasone (P less than 0.01). Six patients (15%) developed extrapyramidal manifestations with metoclopramide, but none with dexamethasone. Furthermore, during dexamethasone therapy, patients developed less diaphoresis, insomnia, headache and dizziness. Upon questioning patients about their preference to future use of the antiemetic drug therapy, 28 patients (70%) preferred dexamethasone, two (5%) preferred metoclopramide and 10 (25%) found no difference. We conclude that high-dose dexamethasone has a greater antiemetic activity and is more safe than high-dose metoclopramide in patients receiving emetogenic chemotherapy mainly without cisplatin.

Leukemia in the eastern region of Saudi Arabia: A population-based study (1987-1988).

This is the first population-based data in Saudi Arabia on the incidence of leukemias in the Eastern Region, as conducted by its regional tumor registry. Data on cancer were captured from all health facilities in the region in 1987-1988. Population census was derived from a survey. Data on cancer deaths were obtained from all death registries. Crude, age-specific, age-standardized, and relative age-standardized incidence rates were used as indicators for the incidence of leukemia. There were 124 cases of leukemias registered. The yearly average crude incidence rate was 5.2 and 3.6 per 100,000 for Saudi males and females, respectively. The age-standardized incidence rate was 7.3 and 6.1 per 100,000 per year in Saudi males and females respectively. The relative age-standardized incidence of leukemias in Saudi males and females ranked, respectively, third and second highest on the international scale. Death from leukemia among Saudis was responsible for 8.9% of the total deaths from cancer. Statistical indicators point to a high incidence rate of leukemias in the Eastern Region of Saudi Arabia among Saudis. Leukemia was the third leading cause of death from cancer. The relative age-standardized rate of leukemias among Saudis of either gender rank very high on the international scale.

CSF hydrocele — unusual complication of V-P shunt

CSF hydrocele as a complication of migration or extrusion of the peritoneal end of the V-P shunt has rarely been reported. Here the case of a 6 month old infant, born at 28 weeks gestational age, is reported. The baby was noted to have scrotal swelling, exacerbated by crying, two months after insertion of ventriculoperitoneal shunt. The hydrocele resolved following revision of the shunt. Possible pathophysiological causes are discussed.

Tecto-cerebellar dysraphia with occipital encephalocele

We report four cases with the rare syndrome of tecto-cerebellar dysraphia with occipital encephalocele. The clinical features seen in these patients included episodic tachypnea and irregular breathing, opsoclonus, ataxia, marked hypotonia of the limbs, coloboma, and polydactyly. All four patients had midline occipital encephalocele. The cranial computed tomography scan showed partial to total agenesis of the vermis with a large communication between cisterna magna and the fourth ventricle. The computed tomography scan also showed partial deficiency of the midbrain tectum. We discuss the clinical and radiological findings and review the literature.

Brain abscess in Saudi Arabia.

There are significant variations among countries in the incidence of brain abscess. We report here 26 cases of brain abscess treated at the Neurosurgery Department of King Faisal University and Dammam Central Hospital Saudi Arabia over a six year period (1982–1988). This is 2.3% of total admissions to the two neurosurgery departments serving a population of approximately 1.2 million in the same period.Young males were most often affected (M/F ratio 3.3:1; 31% were less than 15 years old, 46% aged between 15–39 years, and 23% older than 40 years). Streptococcus was found to be the most common microorganism (38.4%). Mixed infection was seen in 15.3%, and sterile abscesses were found in 11.5% of the patients after aerobic and anaerobic cultures of the pus. Chronic otitis media and paranasal sinusitis predisposed the patients to abscess formation in 57.6% of the cases. The temporo-parietal area was the commonest site. Epilepsy was a complication in 30.7% of our patients, and the mortality rate was 15.3%.

C.N.S. Tumors in Eastern Saudi Arabia

In Saudi Arabia, there were no attempts previously to describe a population based frequency or incidence, particularly so the age adjusted incidence of various CNS tumors. This paper presents the primary CNS tumors from a population based tumor registry over two years period, from January 1987 till December 1988. There was a total of 85 cases representing 5.4% of the total captured cases (1,568 cases of malignant tumors at all sites). The population of the Eastern Province is estimated to be 1.37 million, the Saudis forming 80% of the total population. Out of the 85 cases captured over two years, there were 64 cases diagnosed in indigenous Saudi population forming 75%. The remaining occurred in non-Saudi residents. The male/female ratio in Saudis was 1:1.1 with a slight predominance of the female, while the reverse is true in the non-Saudis (2:1). The total captured cases per annum is 43, making the incidence of primary CNS neoplasms in the Eastern Province of Saudi Arabia 3.1/100,000 of all the population and 2.9/100,000 in Saudi nationals. Comparing this incidence to the international figure, it was clear that it is far less than the incidence reported from North America and Europe, particularly in the Caucasian population, but similar to incidences reported in the Chinese, black Americans, Romanians and Yugoslavians, but certainly less than the Ashkenazi or Safari Jews, and slightly higher than the incidence reported in Japan and Southeast Asia. Malignant brain tumors of various types dominated the primary CNS neoplasms reported over these two years forming 69% of the cases and 52% of the primary brain tumors.

Differentiating medulloblastoma in adults

We present two cases of medulloblastoma in adults patients showing extensive astrocytic differentiation. In one case, there was synchronous oligodendroglial differentiation, both changes appearing after treatment with radiotherapy. The possible role of radiotherapy in the differentiation is discussed.

The use and misuse of the CT scan of the brain.

Analysis of the results of 897 computerized tomographic (CT) scan examinations of the brain, performed on a wide range of patients over a one-year period was carried out to evaluate the use and possible misuse of the CT scan. During the one-year period, over one-half of the brain scans performed were normal and only 32.7% of CT scans demonstrated a reportable abnormality. The results show a general tendency to request CT scans demonstrated a reportable abnormality. The results show a general tendency to request CT scans on patients with little indication for this expensive investigation. This, in return, calls for steps to justify the use of the CT scan facility by means of a medical audit in order to reach optimum efficiency and significant cost effective savings for health institutions in the Kingdom.