Detection and localization of infection can still be a dilemma for both clinicians and imaging specialists. The list of morphologic and physiologic modalities is increasing with the advancement of research, expanding the applications of existing modalities and developing new radiopharmaceuticals for infection imaging. Since no single modality is appropriate for all situations, imaging strategy for the diagnosis of infection in both soft tissue and bone should be tailored for individual patients according to the detailed clinical data including the history of underlying and previous disease processes and the site of suspected infection for proper and cost effective utilization of the different imaging modalities.

Gallstone disease is still a major health problem worldwide. Open cholecystectomy was the standard treatment for symptomatic gallstones for more than 100 years. The introduction of laparoscopic cholecystectomy in the late 1980s has led to dramatic changes in the management of gallstone disease. The aim of this review is to equip the general practitioner with the answers to questions a patient may ask about the current management of gallstones.

The increasing life expectancy in Saudi Arabia will be accompanied by an alteration of the patterns of disease similar to that in Western countries. One of these will be cancer, the second leading cause of death in the west at present, where 1:3 people develop cancer during their lifetime and 1:4 die of it. Cancer deaths are rarely easy. The distress particularly the pain it can cause is legendary. Palliative care is the care and study of patients with active progressive far advanced disease, where cure is impossible, the prognosis predictably short, and the focus of care is the patient's quality of life. A Palliative Care Program has been developed at KFSH&RC, since 1991. This has broadened the spectrum of health services available to cancer patients. Palliative care needs to be more widely available in the kingdom to relieve an important cause of human suffering.

Objective : To assess the quality of the pharmacological control of hypertension. Design: A cross-sectional study. Subjects: Primary health care centers-registered hypertensive patients. Setting: Primary health care centers in Al-Khobar, Saudi Arabia. Methods: Data was recorded, using a structured questionnaire, through direct interviewing of patients, and from their medical records. It included demographic characteristics, hypertension related, and doctors'-related variables; and patients' utilization of other health facilities and whether they had other chronic diseases. Results: The proportion of patients with controlled hypertension was 37%. It was significantly increased with age below 55 years, with non-Saudis, duration of treatment shorter than 5 years; and with the use of monotherapy. Doctors' care-related variables did not show significant variation with the number of controlled patients which may imply that the quality of follow-up might not be adequate. Conclusions: The proportion of controlled patients cared for in the PHC centers is low. The factors associated with control were age, and the use of a single antihypertensive drug. The study questions the quality of follow-up of patients by the PHC physicians.

Objectives: To determine the prevalence of cardiovascular risk factors among students in Jeddah, Saudi Arabia. Methods: A cross-sectional study was conducted during 1994 on a sample of students selected from 49 public schools using a multistage stratified random sampling technique. For all students, an interview was conducted and anthropometric and blood pressure measurements were obtained. Fasting glucose and total cholesterol levels on a capillary blood sample were measured using Accutrend for a subsample of students. Results: Of the 4042 students selected, 71% were males and the overall mean age was 15.3 ± 2.7 years. After age adjustment, about 23% of the students were found overweight. In addition, 6.4% and 9% of the students were found to have systolic and diastolic hypertension, respectively, with no statistically significant difference between males and females. Among 1432 students, 4% of males and 2% of females had hypercholesterolemia (p=0.06). Hyperglycemia was found in 0.4% of males and 0.6% of females. Among 1834 students in the 9 ^th to 12 ^th grades, 6.9% of males and 0.5% of females were current cigarette smokers. Conclusions: Since attitudes and behaviors that influence future health are established during childhood and adolescence, intervention to prevent cardiovascular diseases (in adult life) should take place in childhood and youth to reduce the risk factors and schools have a great role to play in the promotion of good health.

Objective: To identify the pattern of drug-susceptibility of newly diagnosed pulmonary tuberculosis patients in Riyadh, we conducted a study on all Mycobacterium tuberculosis positive-culture patients admitted to Sahari Chest Hospital from January 1994 to April 1995. Methods: Demographic data, antituberculous therapy and drug-susceptibility testing results of each patient were reviewed from patients' hospital records. The samples were cultured on Lowenstein-Jensen media and drug susceptibility was tested by Bactec 12B (Middlebrook 7H12) media against selected antituberculous drugs Results: Drug susceptibility was performed on 362 (91%) of the sputum positive-cultures. The overall initial resistance rate (1 or more drugs) was 12.4%. Initial. resistance was more common with a single drug (9.4%), followed by two drugs (2.3%) and then three drugs (0.3%). Resistance to isoniazid was most common (10.4%), followed by streptomycin (2.7%), rifampicin (1.9%) and ethambutol (0.6%). Single isoniazid resistance was 60%, followed by two drugs: streptomycin and isoniazid (13.3%). Conclusion and Recommendations: Resistance to multiple drugs is not yet a significant problem in Riyadh. A continuous monitoring of drug resistance is important for planning and assessing the national TB control program. Timely and complete reporting is essential to identify the problem as and when it begins.

Objective:> To study the prevalence and causes of infantile hydrocephalus. Methodology: Retrospective study of cases of infantile hydrocephalus comparing results with regional and international trends. Results: Infantile hydrocephalus (IH) affected 62 infants from among 87,127 registered total live births giving an overall incidence of 0.71/1000. Eighteen cases (29%) with spinal dysraphism, 15 cases (24%) with acqueductal stenosis, 9 (14.5%) post meningitis, 6 (9.7%) post haemorrhagic, 6 (9.7%) with structural Central Nervous System (CNS) anomalies (holoprosencephaly 2, hemispheric cysts 2, brain dysgenesis 1, and vascular anomaly 1), 3 (4.9%) congenital idiopathic, 2 (3.2%) Dandy-Walker malformation, 2 (3.2%) toxoplasmosis and one case (1.6%) achondroplasia. Prenatal factors accounted for 46 cases (74.2%) of this series, while postnatal factors accounted for 16 cases (25,8%). Of the latter group, 9 (14.5%) were due to meningitis while 6 (9.7%) were post haemorrhagic. Of the postnatal group there were 8 preterm babies (4.7% of the total series and 53.3% of the postnatal group). Conclusion: While the incidence of infantile hydrocephalus in this region remains statistically unchanged, new characteristics have emerged. It is interesting to notice the increased number of premature babies in the postnatal group. More associated CNS malformations have been noticed in the prenatal group. Still prenatal causes form the bulk of all cases.

Inhalation of metallic foreign bodies is a rare event occurring mostly in children, and often requires early surgical intervention to avoid complications. We report a case of spontaneous expectoration of an intrabronchial metallic nail in an adult, 2 hours after inhalation.