أبحاث ومقالات

Objectives: High-resolution computed tomography (HRCT) can detect the structural abnormalities in asthma. This study attempts to correlate these abnormalities with clinical and pulmonary function test (PFT) data.

Methods: Consecutive stable asthma patients attending Mubarak Al Kabeer Hospital, Kuwait, were subjected to HRCT during a six month period from July 2004 to December 2004, after initial evaluation and PFT.

Results: Of the 28 cases, sixteen (57.1%) had moderate, 6 (21.4%) had mild and 6 (21.4%) had severe persistent asthma. Bronchial wall thickening (57.1%), bronchiectasis (28.6%), mucoid impaction (17.9%), mosaic attenuation (10.7%), air trapping (78.6%) and plate like atelectasis (21.4%) were noted.

Conclusion: Abnormal HRCT findings are common in asthma; however, air trapping when present was not related to the duration or severity of the illness or to the FEV1.

No abstract available on PubMed. This is a commentary on the effects of lumbar discectomy on disability and depression in patients with chronic low back pain, discussing minimally invasive percutaneous techniques including nucleoplasty and their role in pain relief for lumbar disc disease.

Background: Nucleoplasty appears a successful minimally-invasive treatment for symptomatic contained disc herniation (protrusion). The purpose of this prospective study was to assess the effectiveness of nucleoplasty for alleviating pain and dysfunction in our patients.

Method: All patients who presented with established low back and/or leg pain of at least 3 months' duration were clinically followed for 1 year following the nucleoplasty procedure. Self-reported grading of pain using the Visual Analogue Scale (VAS) and the Roland Morris Disability Questionnaire (RMDQ), and subjective global rating of overall satisfaction were recorded and analysed.

Results: Eighty-three patients, aged between 20 and 65 years who were treated with nucleoplasty were included in the study. No complications were noted. At the 12-month follow-up, the median VAS and RMDQ scores were significantly reduced in the patients who were considered successful (VAS by 6-7 points, RMDQ by 8 points).

Conclusions: This disc decompression procedure was a safe and effective treatment option for carefully selected patients affected by low back and leg pain due to contained disc herniation.

Purpose: To evaluate the usefulness of the DIAM device in patients affected by low back pain due to degenerative disc disease.

Methods and materials: Fifty-two consecutive patients were included in the study. There were 29 females and 23 males, aged between 29 and 77 years. The patients were followed for pain by VAS and for functional status by Roland-Morris Disability Questionnaire. The minimum follow-up was 24 months.

Results: Forty-six patients (88%) were considered as success and 2 (4%) were considered as failure. No long-term complications were observed.

Conclusions: This preliminary report indicates that the DIAM device could possibly be useful in the treatment of LBP due to DDD. Further research with RCT is necessary to confirm these preliminary results.

Objectives: The aim of this prospective study was to assess the accuracy of 64-multidetector-row computed tomography coronary angiography (CTA) in the diagnosis of coronary artery disease (CAD).

Results: For patient-based analysis, CTA had a sensitivity of 95%, a specificity of 96%, a positive predictive value of 98% and a negative predictive value of 90%.

Conclusion: The sensitivity and specificity for patient-based analysis and for the main coronary vessels were high, confirming that a negative CTA is useful to rule out significant CAD.

Background: This study was conducted to determine the utility of digital rectal examination (DRE), transrectal ultrasonography (TRUS) and serum prostate-specific antigen (PSA) in the diagnosis of prostate cancer in men in Arabia.

Results: Of 329 patients who had prostate biopsies, 109 cases (33.1%) had prostate cancer. DRE(+) tripled the probability for cancer. The presence of all three factors increased the cancer probability by 6 to 7 fold.

Conclusion: TRUS findings are dependent on PSA for interpretation while DRE(+) with elevated PSA makes prostate cancer more likely.

Background: This study was undertaken to assess the utility of prostate specific antigen (PSA) and PSA density (PSAD) in discriminating between benign and malignant prostate disease in the Kuwaiti Arab population.

Results: Of 100 prostate biopsies, 33 cases were confirmed to be prostate cancer. The discriminating power of serum PSA was 0.686 while that for PSAD was 0.732.

Conclusions: PSAD value less than 0.32 with PSA less than 10 ng/ml strongly suggests benign disease.

Objective: To compare the incidence and complications of extravasation of low-osmolar nonionic contrast media, injected manually and by the automatic power injector (API).

Results: Of the 3,560 patients contrast media extravasation occurred in 11 (0.3%). None of the patients had any soft tissue injury.

Conclusion: The incidence of contrast media extravasation is not significantly increased by the use of the API.

Objective: To evaluate the role of magnetic resonance imaging (MRI) in preoperative assessment of fistula-in-ano.

Results: Twenty-one of 26 patients demonstrated active fistulas. The MRI findings were in accordance with surgical findings in 15 of 16 cases.

Conclusion: MRI showed accurate correlation with surgical findings and aided in preoperative management and planning for surgery.

Objective: Clinical examination has a low positive predictive value for the presence of a goiter compared with ultrasonography. We studied whether the complicated ultrasonographic assessment could be simplified.

Results: Only the lateromedial dimension of the thyroid lobe had a significant correlation to lobe volume, accounting for 82.5% of the variability.

Conclusions: A simple linear ultrasonographic measurement of the thyroid lateromedial dimension is as good as more complicated measures of thyroid volume estimation.

Background: Spinal tuberculosis is perhaps the most clinically important extrapulmonary form of the disease. Early recognition is necessary to minimize residual spinal deformity and/or permanent neurological deficit.

Conclusions: MRI offers excellent visualization of the bone and soft tissue components of spinal tuberculosis. CT is useful in assessing bone destruction but is less accurate in defining epidural extension.

Objective: To study the effect of fasting on the technical success of abdominal ultrasound examination.

Methods: In a randomized, prospective study, 150 patients were divided into two groups with instructions to fast for six hours or have normal breakfast respectively.

Conclusion: It appears that routine fasting before abdominal ultrasound is not necessary.

Background: Abdominal tuberculosis is endemic in the developing world and is reemerging in the West. It is important to be familiar with the CT features of the disease.

Results: Peritoneal involvement was the most common feature (77.5%) with ascites seen in more than half the cases (55.2%). Other findings included lymphadenopathy (46.9%), bowel wall thickening (38%) and solid organ involvement (20.4%).

Conclusions: CT reliably demonstrates the entire range of findings which need interpretation in the light of clinical and laboratory data.

Objective: To retrospectively analyze the role of ultrasound imaging and US-guided fine needle aspiration cytology in the diagnosis and management of abdominal hydatid cyst disease.

Results: The overall accuracy of ultrasound in the diagnosis was 80% (44/55 cases). For the 11 remaining undiagnosed cases, US-guided fine needle aspiration cytology established the diagnosis in all 11, without precipitating complications.

Conclusion: Ultrasound alone was valuable for diagnosing and localizing hydatid cyst disease. US-guided fine needle aspiration cytology was useful in cases where US alone was ineffective.

We carried out a prospective brain MRI study among otherwise normal sickle cell disease patients in Kuwait. The study group consisted of 30 patients aged 6 to 17 years. Only one patient showed hyperintense signals consistent with small infarcts, giving a prevalence of 3.3%. Silent brain infarcts are uncommon in our patients, and the protective factors remain to be fully elucidated.

Background: Gastro-oesophageal reflux is a common disorder encountered during childhood. There are several methods for diagnosis with variable opinions regarding which is most sensitive and specific.

Results: Oesophageal pH probe studies showed a high detection rate (83%) and low false-negative results (7%) compared to barium examinations (43% detection, 48% false-negatives).

Conclusions: 24-hour oesophageal pH monitoring should be used as the first line of investigation for GOR in all children regardless of age group.

This prospective study was conducted in 115 subjects selected from 732 patients with advanced chronic renal failure. Renovascular disease was seen in 15 patients and significant bilateral renal artery disease leading to ischemic renal disease was observed in 13 (11.3%). Corrective procedures were performed in 5 patients with significant improvement. This study denotes a lower prevalence of ischemic renal disease in the advanced CRF population; specific corrective treatment delayed progression significantly.

We evaluated the diagnostic accuracy of magnetic resonance cholangiography (MRC) in 50 patients suspected of having bile duct disease. In the diagnosis of choledocholithiasis, MRC yielded a sensitivity of 95%, a specificity and an accuracy of 96%. Bile duct stenosis was diagnosed with a sensitivity and specificity of 100%. MRC exhibited high accuracy in diagnosing bile duct stenosis and choledocholithiasis.

We carried out a prospective MRI study of the hip in 30 sickle cell disease patients. A total of 8 (26.7%) patients had varying degrees of osteonecrosis of the hip. The SS patients with osteonecrosis had a significantly higher number of hospitalizations for vaso-occlusive crisis in the preceding 3 years than those without osteonecrosis.

Over a period of one year, 1,636 patients undergoing intravenous urography were analysed for urographic features of schistosomiasis. A total of 136 patients revealed classical urographic features. In addition, 8 patients (6%) revealed a "drooping kidney" appearance. Renogram revealed poorer renal function on the affected side. "Drooping kidney" is a new urographic feature of urinary schistosomiasis with therapeutic implications for urologists.

This paper presents an expansile lesion of the temporal bone, in a 14-year-old boy, that was initially diagnosed as intra-osseous meningioma from CT appearance. At histopathology a final diagnosis of giant cell tumour was made. A brief review of the literature is presented for this rare case.