relation between dual energy x-ray absorptiometry measurement of body fat composition and plasma ghrelin in patients with end-stage renal disease

To clarify the role of ghrelin in malnutrition in uremia and its relationship to fat composition using dual x-ray absorptiometry DXA. This is a cohort study including Group I: 60 patients with end stage renal disease 30 on hemodialysis [group IA] and 30 pre-dialysis [group IB] and Group II: 20 controls. This study was carried out in Cairo University Hospital, Kasr Al-Aini, Cairo, Egypt in 2007. Body fat composition total, differential, and lean body mass was assessed using DXA, and plasma ghrelin was measured. Ghrelin was significantly higher in hemodialysis and pre-dialysis groups compared to the control group, and higher in hemodialysis group compared to the pre-dialysis group. In hemodialysis, ghrelin was negatively correlated with weight, body mass index BMI, and truncal fat mass, and positively correlated with serum creatinine. In pre-dialysis, ghrelin inversely correlated with weight, BMI, and truncal fat mass, and positively correlated with serum creatinine, lean body mass. In control, plasma ghrelin showed negative correlation with weight, BMI, truncal fat mass, and body fat mass, and positive correlation with lean body mass. Ghrelin was markedly elevated in renal failure due to its decrease in excretion. Negative correlation between ghrelin and fat composition was detected in dialysis patients. Serial evaluation of body fat composition using DXA is recommended for assessment of nutritional status of those patients

Bone Mineral density in Egyptian cirrhotic patients

Osteopenic bone disease is a well-recognized complication of liver cirrhosis. The aim of this work was to determine the bone mineral density [BMD] in Egyptian cirrhotic patients and to correlate the results with various clinical, laboratory and ultrasonographic characteristics. Thirty-eight cirrhotic patients, 18 males and 20 females were included in this study. They were subjected to complete history taking, clinical examination, abdominal Ultasonography Dual X-ray absorptiometry [DXA] for BMD measurement. BMD was measured in the lumbar spine, proximal femur and forearm. 32 [84.2%] patients had abnormal DXA finding. Osteoporosis was present in 42.1%, 15.8 and 10.5% in lumbar spine, forearm and femurs respectively. Osteopenia was present in 42.1%, 31.6% in lumbar spine, forearm and femurs respectively. The detection of abnormal DXA in lumbar spine was significantly higher compared with that in femurs and forearm. Aspartate transaminase [AST] and alanine transaminase [ALT] were significantly lower in patients with abnormal DXA finding. Body mass index [BMI] and AST were significantly lower in patients with fracture risk. Also, collaterals detected by ultrasonography were significant prevalent in patients with fracture risk. BMI, Mid-upper arm circumference [MAC], hemoglobin, and BMD of lumbar spine forearm were significantly lower in patients with collaterals. 27 [71.1%] patients complained of poor health indicating physical inactivity had significantly lower MAC, hemoglobin, BMD of lumbar spine and forearm. Significant negative correlations were found between age of patients and BMD of their lumbar spine and forearm. MAC, Serum total protein, AST, ALT and hemoglobin had significant positive correlation with BMD. T score of forearm was significantly lower in patients with history of hepatic encephalopathy. No significant correlation were found between DXA findings and duration of lever disease, BMI, Child-pug's score, serum albumin, serum bilirubin, prothrombin time and ascites grade. Significantly lower BMD of left femur and forearm was found in females compared with males. In postmenopausal females, a significant negative correlation was found between duration of menopause and BMD of forearm. A significant positive correlation was found between number of pregnancies and T score left femur. Osteopenic bone disease was highly prevalent in Egyptian cirrhotic patients and was most evident in lumbar spine. BMD was not correlated with criteria of severity of liver disease. It was significantly lower in females but not influenced by menopausal status

Right lower quadrant pain: Evaluation of the sensitivity, specificity and predictive values of ultrasongraphy and colour doppler in the diagnosis

The aim of this study was to evaluate the role of the gray-scale ultrasound and color Doppler in the diagnosis of various causes of right lower quadrant pain. Eighty patients [27 males and 53 females with age range 5-70 years] were included in this study. In 25 cases, gastrointestinal pathology, including appendicitis [22 cases], Crohn's disease [one case] and intussusception [two cases], was detected. Gynecological abnormalities in 34 cases were ectopic pregnancy in 10 cases, ovarian lesions in 24; Dermoid cyst [6], simple cysts [4], endometrioma [8], complicated cysts [6] including one case of tubo-ovarian abscess. Stone lower end right ureter was met within seven cases. One case showed lipoma of the right rectus muscle. The remaining 13 cases were normal. All cases were subjected to preliminary abdominal and pelvic ultrasound using 3.5-5 mHz curvilinear probe, followed by graded compression technique using 7-12 mHz linear array transducer. Transvaginal examination was performed in 30 cases. Color Doppler study was performed in 50 cases to detect vascularity. CT was done in two cases [complicated appendicitis]. MRI was done in 10 complex ovarian masses for better lesion characterization. The findings were correlated with surgical, histopathological and clinical follow-up findings. From the results obtained, it was concluded that the use of ultrasound examination in the evaluation of different causes of RLQ pain showed sensitivity, specificity, positive and negative predictive values of 96, 100, 100 and 81%, respectively. The combination of gray scale and color Doppler study improved the diagnostic accuracy. Abdominal ultrasound using graded compression technique could help in detecting cases of acute appendicitis and differentiating them from other gastrointestinal or gynecological lesions. Transvaginal ultrasound study was a great help in verifying different gynecological lesions including ectopic pregnancy and right ovarian lesions

Cosmetic breast surgery: ultrasound evaluation

Several types of cosmetic breast surgery including breast augmentation, reduction and reconstruction are commonly practiced nowadays. Mammograms after breast conservation therapy for carcinoma of after cosmetic surgery require correlation with physical findings and surgical procedures performed. Mammographic appearances or post surgical changes after these procedures are commonly encountered. Ultrasonography is a useful complement to mammography in evaluation of post-operative changes. Aim of the Study: Was to evaluate the role of the gray- scale ultrasound in the postoperative follow-up and detection of complication after various types of cosmetic breast surgery. Subjects and Twenty six female patients were included in the study, [age range 14-52 years]. Standard mamrnographic views [cranio-caudal and mediolateral oblique were taken in 24 cases, in the other two cases [early post operative] mammography was painful. Ultrasound evaluation was undergone in all cases. MRI was done in 2 cases. In 6 cases with breast augmentation, 3 cases were normal, the other three showed extracapsular rupture in 4 implantes, internal wall derangement in two, breaks and internal echoes inside in one implant, in this case MRI axial and sagittal spin echoes was done, it confirmed the intra and extracapsular rupture. Regarding the reduction mammoplasty [11 cases]: Us replaced mammography in early postoperative cases [2 cases] with tender inflamed breasts, in three cases mass discrimination fibroadenomas, cysts and fat necrosis was accurately assessed. In Reconstructed breast [9 cases]: Us was complementary to mammography in assessment of ill defined dense area. Us guided fine needle biopsy was done in 2 cases of fat necrosis. Ultrasound examination is highly sensitive and specific in post-operative assessment of saline implants integrity in augmentation mammplasty. Ultrasonography is a useful complement to mammography in demonstrating the origin of a palpable mass after other types of surgery, US guided fine needle biopsy is minimally invasive technique in confirming the diagnosis of suspicious mass