Nonalcoholic fatty liver disease of two ethnic groups in Kuwait: comparison of prevalence and risk factors

To assess the prevalence of nonalcoholic hepatic steatosis [nonalcoholic fatty liver disease, NAFLD] and the significance of some risk factors, such as obesity and glucose metabolism impairment, for two major ethnic groups of Kuwait: Arabs and South Asians. 143 adults [Arab: n=81; South Asian: n=62] were enrolled in the study. Anthropometric measurements including body mass index [BMI], waist circumference [WC], hip circumference [HC] and waist-to-hip ratio were performed along with abdominal ultrasonography. The prevalence of liver steatosis was assessed; its relation to glucose metabolism impairment, obesity, age and gender was compared in the two ethnic groups. Except for waist-to-hip ratio, the anthropometric parameters were higher in Arabs than South Asians. The respective parameters in Arabs and South Asians were: BMI: 30.9 +/- 6.6 versus 27.0 +/- 4.5, p<0.001; WC: 101.5 +/- 16.4 versus 94.0 +/- 12.2, p=0.002; HC: 106.6 +/- 12.4 versus 99.2 +/- 9.9, p<0.001. Although Arabs were more obese, they did not exhibit a higher prevalence of steatosis [33.3 vs. 29.0%, p=0.583]. According to multivariate analysis, only gender [odds ratio 3.93, p=0.005], glucose metabolism impairment [odds ratio 4.94, p=0.003] and WC [odds ratio 4.75, p=0.012] remained significantly associated with steatosis. No significant difference in NAFLD prevalence was found between Arabs and South Asians. Only gender, history of impaired glucose metabolism and abdominal obesity expressed by WC had an independent predictive value for developing liver steatosis

Spontaneous intracerebral hematoma in young people: clinical and radiological magnetic resonance imaging features by diffusion-weighted images

Spontaneous intracerebral hematoma [ICH] accounts for 10% to 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage. The etiologic spectrum of ICH in young people may be wider than in older individuals and includes vascular malformation, hypertension, and drug use. The aim of this work is to study risk factors, causes, sites, and early prognosis of spontaneous intracerebral hematoma [ICH] in young people through determining the clinical and radiographic features of the cases selected at different stages using Diffusion-Weighted images [DW-I] in comparison with different conventional Magnetic resonance imaging [MRI] sequences. This study was carried out on 40 [16 males and 24 females] young patients [15-45 years old] with spontaneous ICH who were admitted to the neurology department in Mansura Emergency Hospital or Mansura University Hospital. They underwent thorough history taking, neurological examination, laboratory investigation and radiological imaging in the form of non-contrast axial Computed tomography [CT] scan of the brain in 38 patients, conventional MRI with multiple sequences including T1-, T2-, FLAIR-, GRE-WIs and D-WI and apparent diffusion coeffient [ADC] map in all patients. MR angiography and digital subtraction angiography were done in 27 and 9 patients respectively. According to the time interval between symptoms onset and MRI study, five stages were categorized, hyperacute [n=2], acute [n=5], early subacute [n=12], late subacute [n=14] and chronic [n=7]. The signal intensity at different stages of ICH on D-WI and the ADC value were compared with those on the different conventional MRI sequences. The frequency of risk factors among the studied groups showed that hypertension was the commonest risk factor [20 patients]. The most common presenting feature of ICH young patients is focal neurological deficits 92.5%. The commonest cause was hypertension 42.5% followed by AVM 20%. Among the 40 patients 12 patients died within the first month with a mortality rate 30%. All hematomas were proved on CT and appeared as hyperdense lesions. Different MR signal intensities were identified on the D-WI and conventional MRI sequences. D-WI and ADC values identified different stages of ICH. ICH in young people needs more research studies. Hypertension is the most common risk factor for stroke in young adults. AVM, aneurysm, and cavernous angioma must be considered as possible cause in each case of ICH in young people even in presence of hypertension. The addition of D-WI and ADC map to conventional MRI study helps the differentiation of various stages of ICH from acute infarction as well as the characterization of intracranial hemorrhagic lesion

Treatment of central giant cell granuloma of the mandible with intralesional injection of corticosteroid

This study was carried-out to report our experience with ten cases of central giant cell granuloma [CGCG] of the mandible treated with intralesional injection of corticosteroid with special reference to the possible effect of corticosteroid on CGCG microscopically and by DNA cytophotmetry. Ten patients with CGCG of the mandible were included in this study. Triamcinolone acetonide was injected into the lesions, the injection was repeated weekly for a total of six weeks. Panoramic radiographs were obtained every three months to evaluate the healing process. Complete regression of the lesions was proved in three patients with no evidence of recurrences during a follow-up period of one year. The other seven cases needed surgical excision, which revealed significant decrease in the number [P=0.001] and size [P=0.01] of multinucleated giant cells [MNGCs]. Whereas, no differences were reported between the number of blood vessels, DNA content and ploidy pattern of MNGCs before and after the intralesional corticosteroid injection. It could be concluded that, this form of treatment may be advantageous, particularly for large lesions in order to cure or reduce the size of the lesion and thus minimize the need for extensive surgical resection that could result in functional and esthetic deficits

Spinal canal remodeling after stabilization of thoracolumbar burst fractures

Bone fragments in the spinal canal after thoracolumbar burst fractures causing spinal canal narrowing is a frequent phenomenon. Efforts to remove such fragments are often considered. The aim of this study was to evaluate the spinal canal remodeling after posterior instrumentation and fusion. 24 patients with unstable thoracolumbar burst fractures were treated in Mansoura Emergency Hospital by transpedicular instrumentation and fusion using autogenous iliac bone graft. There were 16 males and 8 females, their age ranged from 18 to 54 years with a mean age of 34 years. 16 patients had burst fracture at L1 level, 4 patients had fracture of L2, 2 patients had fracture of T12 and another 2 patients had fracture of T11 level. Preoperative CT scan was done routinely for all the patients and sometimes with sagittal reformat to evaluate the pattern of the fracture and the degree of canal compromise. Also detailed neurological evaluation for the patients was achieved and documented. 15 patients had partial neurological insult while 9 patients were neurologically intact. The type of neurological deficit in all patients was scored on the scale of Frankel et al. Spinal canal cross sectional areas [CSA] were measured preoperatively, within 1 week postoperatively and at least 2 years after surgery. The results showed that the preoperative canal encroachment averaged 48.83% [range 30%-72%] of the estimated original area. The 16 patients with neurological deficit had significantly more severe initial canal encroachment [mean 53%] than those who were neurologically intact [mean 41%]. Postoperatively, canal encroachment had decreased to a mean of 33.87% [range 18-55%], at the end of follow-up, canal encroachment was further reduced by resorption of bone fragments to a mean of 12.08% [range 0-32%]. Our results showed statistically significant difference in spinal canal areas postoperatively and at the end of follow-up suggesting effective remodeling of the spinal canal after surgical treatment of thoracolumbar burst fractures with posterior instrumentation and fusion. All patients with neurological deficits improved, and only 4 patients had residual neurological affection. our study shows that canal enlargement during surgery is caused by indirect effects when the spine is distracted and put into lordosis. Remodeling will occur if there is residual narrowing. Acute intervention into the spinal canal, as well as subsequent anterior surgery because of residual bone, should be limited

Virtal CT colonoscopy versus conventional colonscopy: a prospective study

Thirty-two patients [22 males and 10 females, mean age 47 years] with different colorectal complaints were investigated by CT colonography. The scanning parameters were collimation of 5 mm, table speed of 6.25 mm/s and pitch of 1.25. All images were evaluated in axial slices, reformatted images with endoluminal and extraluminal views. All patients were reexamined by the conventional colonoscope, CT colonography and colonoscopy. The study concluded that the high resolution and multiple image display of CT colonography allow the detection of many colorectal lesions. CT colonography is also a noninvasive imaging modality that is particularly valuable in poor risky patients and for colorectal examination proximal to an obstructing lesion