Evaluation of Bone Mineral Density in Patients with Chronic Low Back Pain

STUDY DESIGN: This was designed as a retrospective study. PURPOSE: We investigated the relationship between bone mineral density (BMD) and chronic lower back pain (LBP). OVERVIEW OF LITERATURE: In spite of a large number of epidemiological surveys on the prevalence of LBP and BMD measurements completed separately in the general population, the relationship between the two has not been well documented. METHODS: The study included 171 patients with chronic LBP who underwent the BMD study. The control group was selected from our database regarding BMD without LBP. RESULTS: A total of 678 subjects, aged 18 to 100 years (mean, 49.9+/-12.9 years) were included in the study, 25% (n=171) of the subjects had LBP. Compared to those patients without LBP, patients exhibiting LBP had statistically significant lower mean weight, hip and spine BMD and T-score. Lower BMD and T-scores were significant regardless of the age group, gender, menopausal status, and obesity classification. CONCLUSIONS: Chronic LBP has a negative correlation with hip and spine bone mineral density.

Appendicitis caused by accidentally ingested metallic pin: a case report

Foreign bodies [FB] are a rare cause of appendicitis. We report a case of a 29-year-old healthy female who presented to the emergency department after accidentally swallowing a pin while wearing head scarf. Plain abdominal radiograph revealed an opaque metallic pin in the left upper quadrant. She was sent home with reassurance. After a week, she presented to the emergency department again with intermittent abdominal pain. Abdominal radiograph at this stage showed the metallic pin in the right lower quadrant and the decision to intervene was made. Colonoscopic removal failed as the pin could not be visualized. Abdominal CT scan was performed which revealed the pin within the lumen of appendix. At surgery and histopathology, acute appendicitis with ulceration and neutrophilic in filtration at pin contact suggested foreign body appendicitis. Pre-operative CT scan was found to be useful for localization of FB as well as identification of complications

Bone mineral density in Kuwaiti patients with end-stage renal disease

This study compared an ethnically uniform group of end-stage renal disease [ESRD] Kuwaiti patients with a control group of healthy Kuwaiti subjects, in terms of their bone mineral density [BMD] and anthropometric measurements. Included in the study were 94 males and 129 females with a mean age of 48 +/- 10 years. Forty-five males and 53 females had ESRD. The remaining 49 males and 26 females were the control subjects. BMD was measured at total lumbar spine [L1-L4] and total left hip, using dual energy X-ray absorptiometry [HOLOGIC, QRS series, Europe, Belgium]. The data were analyzed using SPSS, version 15 [SPSS Inc., Chicago, III., USA]. The difference in BMD and the anthropometric measurements between the ESRD patients and the controls was assessed. Multivariate linear regression models were used to examine independent effects of ESRD on BMD while adjusting for relevant covariates. The ESRD patients had a lower BMD than the controls at the hip [0.81 +/- 0.11 vs. 0.92 +/- 0.16] and the spine [0.84 +/- 0.12 vs. 0.92 +/- 0.16], p< 0.001. They also had a lower body mass index [27.80 +/- 6.03 vs. 30.85 +/- 6.54; p < 0.001] and were taller [162.56 +/- 15.31 vs. 156.94 cm +/- 10.03; p < 0.01]. The reduced BMD persisted after controlling for confounding effects of sex, age and anthropometric measurements [p < 0.001]. Kuwaiti patients with ESRD had a lower BMD and, therefore, an increased risk of osteoporosis bone fractures

Comparative analysis and interobserver variation of unenhanced computed tomography and intravenous urography in the diagnosis of acute flank pain

The purpose of this study was to compare unenhanced computed tomography [UECT] to intravenous urography [IVU] for detecting urinary tract calculi, signs of obstruction and non-renal causes in the assessment of acute flank pain, and in their interobserver agreement. In this prospective study, carried out at a university hospital over a period of 1 year, 36 patients [27 males and 9 females] participated. Mean age was 44 +/- 15 years [range: 14-73 years].The patients presented with acute flank pain and underwent UECT and IVU. The images were blindly evaluated by 2 experienced radiologists and the two techniques compared using the two-tailed McNemar's test for matched pairs; p values <0.05 were considered significant. UECT detected stones in 11 [30.6%] patients, while IVU found them in only 8 [22.2%]. The increased detection by UECT was due to its ability to detect smaller stones [<6 mm]. UECT was also found to be better than IVU in determining calculus position, in detecting primary or secondary signs of obstruction and in identifying non-urinary causes of flank pain. The overall average of agreement as indicated by kappa values, was 0.88 for UECT and 0.61 for IVU. UECT showed better detectability and interobserver agreement than IVU, suggesting that UECT could replace IVU as the first imaging modality in the evaluation of acute renal colic

Computed tomography for evaluation of adrenal dysfunction A/C- year follow-up

To evaluate the computed tomography [CT] morphology of the adrenal glands of patients with adrenal dysfunction. CT examination of adrenal glands was performed in 331 consecutive patients with symptoms suggestive of adrenal dysfunction. CT was performed using 4-mm contiguous sections for the adrenal area. Intravenous contrast was injected in 78 cases of the adrenal mass lesions. We analyzed 331 consecutive CT scans performed over a 10-year period. One hundred and twenty-seven patients had hypercortisolism, 23 had unilateral adrenal tumor, 18 had bilateral adrenal hyperplasia and 86 had normal adrenals. The CT diagnosis was confirmed at surgery in all 23 unilateral adrenal tumors except in 1 case [tuberculosis in a hyperplastic adrenal gland]. Among the 91 cases of hypertension, 86 were being evaluated for pheochromocytoma and 5 for Conn's syndrome. Forty-three had adrenal pheochromocytoma [1 bilateral] and 10 had extra-adrenal pheochromocytoma detectable on CT. Two of the 5 cases of hyperaldosteronism [Conn's syndrome] had adrenal tumor. Adrenal enlargement was observed in 17 of the 33 cases of Addison's disease. Four of them were cases of histoplasmosis. CT scanning is a sensitive tool for the imaging of adrenal glands. Both neoplastic and inflammatory lesions can alter adrenal gland morphology. Our results highlight the importance of studying adrenal morphology. CT morphology is helpful to decide the modality of treatment

Imaging of the pituitary gland in cushing's disease

To evaluate the sensitivity of computed tomography [CT] and magnetic resonance imaging [MRI] of the pituitary gland in detecting pituitary adenomas in patients with Cushing's disease. Twenty-five patients aged 8-55 years [average age 30 years], clinically and biochemically diagnosed as having Cushing's disease, were evaluated with a contrast-enhanced CT scan and MRI of the pituitary gland. Contrast-enhanced CT scans of direct 2-mm-thick coronal sections were performed. Pre- and post-enhanced MRI of the pituitary gland was performed on a 1.5-tesla superconducting magnet, taking 2-mm-thick sections in the sagittal and coronal planes. MRI revealed adenomas in 16 patients [12 microadenomas and 4 macroadenomas]. Twelve [75%] adenomas were delineated more clearly on post-gadolinium MRI scans. Nine [56%] adenomas were better delineated on coronal images. Out of 16 adenomas identified on the MRI, only 5 were seen on the CT scan. All patients underwent trans-sphenoid surgery and the MRI findings were confirmed. Contrast-enhanced MRI is the preferred modality for the detection of ACTH-secreting adenomas, which are difficult to visualize on CT scans due to their small size. A focal hypointense lesion is the commonest finding on T1-weighted images and, if identified on coronal sections, is the most sensitive diagnostic criterion. However, a negative MRI does not exclude the presence of a microadenoma