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Background: Birth weight is the first weight of the fetus or newborn obtained after birth preferably measured within the first hour of life before significant postnatal weight loss has occurred. Aim of the work: This study was conducted in order to assess the role of measurement of placental thickness and diameter at the third trimester using two dimensional ultrasound in determination of low birth weight. Patients and methods: This study was carried out at Sayed Galal University Hospital and Damanhour Teaching Hospital on "400" uncomplicated pregnant women who was attend the outpatient clinic at Sayed Galal University Hospital and Damanhour Teaching Hospital, two dimensional ultrasound measurement of placental thickness and diameter was done to assess its role in determination of low birth weight. Results: The results of this study show that there were significant positive correlations between neonatal weight and GA, Placental diameter, Placental thickness, Biparietal diameter, Femur length & Abdominal circumference (P 0.05). Also our results shows that there was no statistical significant difference according to parity regarding fetal and placental measures. The results show that there was no statistical significant difference according to fetal sex regarding placental measures (P > 0.05). Conclusion: The result of this study shows a strong positive correlation between neonatal weight and placental thickness, so placental thickness measured at the level of umbilical cord insertion can be used as an accurate sonographic indicator in the assessment of fetal weight.

Background: Gestational diabetes mellitus (GDM) is considered a common complication in pregnancy, affecting greater than 10% pregnancies worldwide. However, the definitive underlying causes still not fully explained. Objectives: This study aimed to detect the predictive value of uric acid level at first trimester in development of GDM. Patients and Methods: The study was conducted on 300 first trimester pregnant females attending the Outpatient Clinic of Al-Azhar University Hospital. All cases underwent measurement of first trimester serum uric acid level. Between 24 and 28 weeks of gestation glucose challenge test was done. Positive cases underwent confirmation by 3 h glucose tolerance test. Results: The Pearson’s test showed that there was a highly significant correlation between serum uric acid at first trimester and plasma glucose levels at 24-28 weeks. Conclusion: There is increased risk in development of GDM with the increase in uric acid level at the first trimester.

Background: The night eating syndrome (NES) was first described in 1955 as a disorder characterized by morning anorexia, evening hyperphagia, and insomnia among obese individuals characterized by unsuccessful weight management. The night eating syndrome (NES) appears to be associated with obesity. This study was primarily undertaken to study the prevalence of Night eating syndrome (NES). Method: Three humdered out of a total of 400 undergraduate medical students voluntarily participated in this cross sectional survey conducted online (self-rated) at a reputed university in Kingdom of Saudi Arabia. Socio-demographic details were recorded on a semi-structured performa. SCOFF was administered to find those at risk of eating disorder. Night eating syndrome questionnaire (NEQ) was used to screen those who had NES. Result: 58% of the sample was male. The mean weight of the total sample was 70.23 (males 79.15 and females 57.9). The mean body mass index was 25.09 for male and 22.64 female. 21% were found to be overweight and 14.3% were obese. The prevalence of NES in the study was 10.3% with comparatively men being at higher risk for NES. Conclusion: High prevalence of obesity and overweight in the sample was similar to what has been reported in the Saudi population. Comparatively high prevalence of NES was found in this study but it was not associated with BMI.

STUDY DESIGN Retrospective, cross-sectional study. OBJECTIVE To evaluate the feasibility of two screws anterior fixation of the odontoid process among Arab adults. SUMMARY OF BACKGROUND DATA Anterior screw fixation is the treatment of choice for type II odontoid fractures. In order to perform the procedure safely, the diameter of the odontoid process should be wide enough to allow for the placement of one or two screws. METHODS A retrospective review of 156 computed tomography scans of the cervical spine was done. The included patients were Arabs, adults (at least 18 years old), and had no evidence of upper cervical spine trauma, deformity, infection, tumor, or surgery. The minimum external transverse diameter (METD), minimum internal transverse diameter (MITD), minimum external anteroposterior diameter (MEAD), and minimum internal anteroposterior diameter (MIAD) of the odontoid process were measured. A P value of ≤0.05 was considered as the cutoff level of statistical significance. RESULTS Our study included 94 (60.3%) males and 62 (39.7%) females. The mean age of the subjects was 37.8 ± 16.9 years (range 18-85). The mean values of the METD, MITD, MEAD, and MIAD were 8.7 ± 1.0 mm, 6.0 ± 1.1 mm, 10.3 ± 1.0 mm, and 7.4 ± 1.1 mm, respectively. Men had larger diameters compared to women. This was statistically significant for METD (P = 0.035) and MEAD (P

Background Transpedicular screw fixation of the cervical spine provides excellent biomechanical stability. The feasibility of inserting a 3.5-mm screw in the pedicle requires a minimum pedicle diameter of 4.5 mm. This diameter allows at least 0.5 mm bony bridge medially and laterally in order to avoid pedicle violation which can result in neurovascular complications. We aim to evaluate the feasibility of this technique in Arab people since no data are available about this population. Materials and methods This cross-sectional study involved a retrospective review of computed tomography scans of normal cervical spines of 99 Arab adults. Ten morphometric measurements were obtained. Data were analyzed using a p value of ≤0.05 as the cut-off level of statistical significance. Results Our sample included 63 (63.6 %) males and 36 (36.4 %) females, with a mean age of 35.5 ± 16.5 years. The morphometric parameters of C3–C7 spine pedicles were larger in males than in females. The outer pedicle width (OPW) was 25 % of all subjects at C3–C6 vertebrae. Statistically significant differences in the OPW between males and females were noted at C3 (p = 0.032) and C6 (p = 0.004). Conclusions Inserting pedicle screws in the subaxial cervical spine is feasible among the majority of Arab people. Level of evidence Level 3.

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.

Objective: To evaluate the accuracy of 64-slice multidetector computerized tomography (MDCT) in the detection of transmesenteric internal hernias in patients following Roux-en-Y gastric bypass (RYGB) for bariatric surgery patients. Subjects and Methods: This retrospective study was performed on post-bariatric RYGB patients presenting with signs and symptoms suggestive of internal hernias at our institution from the period of April 2010 until March 2012. The patients who had symptoms suggestive of internal hernia had undergone 64-slice MDCT. All the patients who on CT examination were found to have features suggestive of internal hernia were subjected to laparoscopic exploration. Results: Of the 102 patients who had undergone laparoscopic RYGB, 42 (41.2%) were suspected of having internal hernia. Of these, 23 (55%) had CT findings of hernia while the remaining 19 (45%) were considered normal. Of the 23, 21 (91%) patients were confirmed for internal hernia at laparoscopy. The 19 (45%) patients that did not reveal any signs for internal hernia on CT and the 2 patients that were considered normal on laparoscopy were treated conservatively. The sensitivity, specificity and positive and negative predictive values for MDCT in the diagnosis of internal hernias were 100, 90.5, 91 and 91.3% respectively. Conclusion: The 64-slice MDCT was accurate in the diagnosis of transmesenteric internal hernias in post-RYGB for bariatric surgery patients. The presence of clustered loops with mesenteric swirl is a reliable indicator of transmesenteric internal hernia.

Menopause is the major risk factor for the loss of bone mineral density (BMD) and bone mineral content (BMC) in women. In this study, we determined the prevalence of osteoporosis in postmenopausal women in Kuwait and compared it with that of other Middle East and west countries. Two thousand two hundred ninety-six postmenopausal women ranging in age from 40 to 87yr were included in the study and divided into 4 age groups by decade. We measured body weight, height, body mass index (BMI), BMD, and BMC. The mean age, height, and weight were 59.1+7.9yr, 154.7+6.5cm, and 77.3+14.9kg, respectively. The mean BMI and BMC were 32.4+6.6kg/m(2) and 0.9+0.14g/cm(2), respectively. The average T-scores for the hip and lumbar spine were -0.280+1.2 and -1.297+1.33, respectively. BMC significantly decreased with age from 0.95 to 0.81g/cm(2). Four hundred forty-four (19.3%) were found to have osteoporosis. The incidence of osteoporosis significantly increased from 4.3% to 39.9% with age, which is lower than that reported for Saudi (40%) and Moroccan women (39.6%) and higher than that for US/European (31%) and Lebanese women (11%).

Objective: To investigate the frequency of ossification of the ligamentum flavum (OLF) in the spine among the Arab population in Kuwait using magnetic resonance imaging (MRI) surveillance of the whole spine. Subjects and Methods: A consecutive series of 102 patients with low back pain were recruited from the outpatient clinic of Mubarak Al-Kabeer Hospital, Kuwait. MRI of the whole spine in the sagittal plane was obtained in at least two sequences (T1 and T2). The OLF was defined as low signal intensity thickening of the ligament in both T1 and T2 sequences on the posterior margin of the spinal canal, causing indentation of the theca with or without cord compression. Results: Of the 102 cases, 19 (18.6%) patients had OLF. Of the 19 positive cases, 12 (63.2%) were present at a single level, and 7 (36.8%) at multiple levels. A total of 26 OLF segments were identified in the following anatomical distribution: cervical: 15 (57.7%); upper thoracic (T1–T4): 1 (3.8%); mid thoracic (T5–T8): 4 (15.4%); lower thoracic (T9–T12): 4 (15.4%), and lumbar region: 2 (7.7%). Of the 19 OLF patients, 2 (10.5%) had tandem ossification of the posterior longitudinal ligament in the cervical spine and were symptomatic. Conclusions: The frequency of OLF appears to be high among this hospital-based cohort of the Arab population. OLF should be kept in mind if a patient presents with radiculopathy, particularly in the cervical region, for which surgical intervention is contemplated.

Introduction: Acute gastrointestinal bleeding (AGIB) is a serious and life-threatening condition. Many diagnostic procedures and tests are being used to detect the site of bleeding with different success rates. The aim of our study is to prospectively evaluate accuracy of 64-slice multi-detector computerised tomography (MDCT) in the diagnosis of lower AGIB. Methods: Between September 2007 and January 2009, patients with presumed lower AGIB were referred to the radiology department of our institution for 64-slice MDCT examination as part of the investigation for the lower AGIB. Any abnormalities to account for bleeding, such as tumours, bowel wall enhancement and increased intraluminal density, were recorded. Results: Out of 139 patients with AGIB that were admitted to our casualty department, 27 patients (19 men and 8 women) in the age range of 24–88 years (mean age, 56 years) were suspected to have lower AGIB. Sixty-four-slice MDCT was performed and considered positive for bleeding in 19 (70%) cases, and in all the cases, the bleeding source was indentified in the arterial phase, showing a focal dense wall enhancement in 8 (42%) cases, circumferential wall enhancement in 4 (22%) cases and progressive increasing intraluminal density in 7 (36%) cases. The venous phase scan showed increased dispersion of the contrast within the lumen as an additional clue for active extravasation in 15 (79%) out of the 19 cases. Delayed 5-min scanning showed the same findings as venous phase in all the 19 positive cases and failed to depict any additional findings in the eight cases that were negative on arterial or venous phases. Conclusion: The study supports the high accuracy of 64-slice MDCT in locating the site of AGIB in patients thought to have a distal source of bleeding. Its accuracy in clinically proximal bleeding is not clear from this study, but MDCT is capable of showing such sources.

Background and Objectives : Radiological and histological evaluations are affected by subjective interpretation. This study determined the level of inter- and intraobserver variation among radiologists for detection of abnormal parenchymal lung changes on high resolution computed tomography (HRCT). Methods : HRCT images of 65 patients known to have systemic lupus erythematosus (with clinical pulmonary involvement) were retrospectively reviewed by four nonthoracic radiologists (two with expertise in magnetic resonance [MR] and two general radiologists). Each radiologist read the scans twice, with an interval between readings of at least 6 months. The interobserver variation among the first and second readings of the four radiologists and the intraobserver variation of each radiologist′s two readings were assessed by the kappa statistic. Results : There was good agreement between the first and second readings of each radiologist. There was moderate agreement between the two readings of one MR radiologist (kappa=0.482); the other three radiologists had kappa values that were good to excellent (0.716, 0.691, and 0.829). There was a clinically acceptable level of interobserver variability between all radiologists. The agreement was fair to moderate between the MR radiologist and the other observers (kappa range: 0.362-0.519) and moderate to good between the other three radiologists (0.508-0.730). Conclusion : The interpretation of imaging findings of abnormal parenchymal lung changes on HRCT is reproducible and the agreement between general radiologists is clinically acceptable. There is reduced agreement when the radiologist is not involved on a regular basis with thoracic imaging. Difficult or indeterminate cases may benefit from review by a chest radiologist.

Resume Objectifs. – La polyarthrite rhumatoide (PR) est une maladie auto-immune complexe et frequente, connue pour etre associee avec certains alleles HLA-DR et ce dans differentes populations. Notre etude a eu pour but d'etudier l'association entre les alleles HLA-DRB1 et la PR chez des patients Koweitiens. Patients et methodes. – Les alleles HLA-DRB1 ont ete determines chez 47 patients atteints de PR et chez 70 sujets temoins apparies de meme ethnie, a l'aide d'une methode de biologie moleculaire utilisant des amorces specifiques d'alleles ou de groupe d'alleles (PCR-SSP). Resultats. – La frequence de l'allele DRB1*04 etait significativement plus elevee chez nos patients par rapport aux temoins (p Conclusion. – Nos resultats montrent l'existence d'une association entre l'allele HLA-DRB1*04 et la PR chez les patients Koweitiens. L'absence d'association entre les alleles HLA-DRB1 et les signes de severite de la PR ne nous surprend pas, dans la mesure ou notre etude a ete effectuee chez des patients suivis a l'hopital et ayant tendance a avoir une maladie plus severe.

Purpose To determine the degree of pain and discomfort associated with transrectal sonography (TRS)-guided biopsy of the prostate and to analyze the complications associated with this procedure. Methods Three hundred men referred as part of an investigation to exclude prostate cancer were studied. The reasons for referral were suspected prostate cancer due to increased serum prostate-specific antigen level (>4 ng/ml), the finding of a palpable nodule or greater firmness of one prostatic lobe than the other on digital rectal examination, or the finding of a suspicious area of neoplasm of the prostate on TRS biopsy. All TRS-guided biopsies were performed as outpatient procedures without anesthesia. Ciprofloxacin prophylaxis was used in all patients before biopsy. Tolerance of the procedure was recorded immediately after the examination and graded on a scale of 0–4 as follows: 0, no pain; 1, very mild pain; 2, moderate pain; 3, severe pain; 4, intolerable pain. Complications recorded in the first week after the procedure were analyzed. They included mild pain, self-limiting hematuria, hematospermia, rectal bleeding, severe hematuria, septicemia, severe hemorrhage of the anus, and vasovagal attack. Results Out of 300 TRS-guided biopsies, 10 early complications were recorded. The most frequent was septicemia, which was seen in 5 cases (1.7%). Hematuria occured in 29 patients, 3 of which were severe. Rectal bleeding and vasovagal attack occurred in 1 patient each. All patients made a full recovery with appropriate conservative management. Ten cases (3.33%) of severe pain (grade 3) and intolerable pain (grade 4) were observed. Three out of these 10 patients completed the procedure. The procedure was terminated in 1 patient, and 6 patients required local anesthetic due to perianal disease. Conclusions TRS-guided prostate biopsy can be performed without local anesthesia in 90% of patients. Prophylactic antibiotics are mandatory to minimize approximately infectious complications. © 2005 Wiley Periodicals, Inc. J Clin Ultrasound33:452–456, 2005

Objective: The aim of this study was to evaluate the capability of magnetic resonance imaging (MRI) to depict and characterize the changes seen in diabetic foot infections. Subjects and Methods: MRI studies of 29 diabetic patients with suspected foot infection were evaluated. Sagittal and transverse T1-weighted images before and after intravenous gadolinium, and transverse fat-suppressed T2-weighted images were performed on the affected regions. The MRI findings were compared to subsequent clinical and/or histopathological findings. Results: The MRI findings were: osteomyelitis in 14 patients, abscess in 5, cellulitis in 26, tenosynovitis in 4 and neuropathic joint in 8. Three cases were normal. Pathological confirmations were obtained in 19 patients. MRI and histological diagnosis were in concordance in 79% of osteomyelitis cases, 100% of neuropathy cases and 100% of cellulitis cases. The sensitivity and specificity of MRI in diagnosing osteomyelitis were 100 and 63%, respectively. The positive predictive and negative predictive values, and the accuracy were 79, 100 and 84%, respectively. MRI helped surgical planning for limb salvage procedures in 6 of the osteomyelitis cases and in a cellulitis case. Conclusion: The results indicate that MRI is a sensitive and accurate imaging modality for the evaluation of foot infections in diabetic patients and for planning proper treatment.

Purpose The aim of this study was to review the incidence and type of seminal vesicle (SV) masses discovered during transrectal sonography (TRUS) of the prostate. Methods Patients were a consecutive series of men referred for TRUS of the prostate because of lower urinary tract symptoms or elevated prostate-specific antigen levels, who were found on TRUS to have SV masses. Patients with prostate cancer involving the SVs were excluded. Cystic lesions were sampled by fine-needle aspiration and solid lesions by core biopsy, all under sonographic guidance. Results Of the 450 patients who underwent TRUS between January 1997 and December 2001, 10 (2%) were found to have SV masses; 5 masses were cystic and 5 were solid. Cytologic evaluation of aspirated specimens revealed benign findings in all 5 cysts. Four of the 5 patients with solid SV masses had chronic schistosomiasis, and the mass in the fifth patient was a metastatic deposit from a renal cell carcinoma. Conclusions SV masses may be responsible for lower urinary tract symptoms in a small fraction of cases. A cystic mass is presumptively benign, whereas a solid lesion has a small probability of being malignant, especially if the patient has a primary neoplasm elsewhere. Schistosomiasis should always be considered when making a differential diagnosis in patients who live in areas where infestation is endemic. © 2003 Wiley Periodicals, Inc. J Clin Ultrasound 31:201–206, 2003

To determine the relationship between femoral notch morphology, femoral notch width index and anterior cruciate ligament tears using magnetic resonance imaging of the knee.This retrospective study was conducted on 560 patients who had magnetic resonance imaging (MRI) examinations of the knee between February 2010 and June 2011. Two morphological changes were investigated: the shape of the femoral notch and its width index. The femoral notch shape was classified into one of three types: Type A, which is a narrow (Stenotic) notch that appears narrowed from the base to the midsection as well as at the apex; Type U, in which the midsection does not taper, allowing for a wider contour to the notch than Type A; and Type W, which has the characteristics of Type U but with two apparent apices. The femoral notch width index was calculated as a ratio of central notch width and transcondylar or intercondylar width; values of 0.270 or more were considered as normal and values of 0.269 or less were considered as below normal. These measurements were correlated with the presence or absence of anterior cruciate ligament (ACL) tears.Of 560 patients, there were 280 cases of ACL tear. Of the 560 patients, 240 had a Type A femoral notch shape and 320 had a Type U or W femoral notch shape. Of those with Type A, 73 % (176 patients) had ACL tears, and of those with Type U or W, 32 % (104 patients) had ACL tears. Statistical analysis showed that the Type A notch correlated with ACL injury (p value 0.0001). The femoral notch width index was low in 37 % (88 subjects) with Type A notch compared with 27.5 % (88 subjects) with Type U or W notches. Of the 280 subjects with ACL tear, only 17 % (48 patients) had a reduced femoral notch index.This study showed that the Type A femoral notch appears to be a risk factor for ACL injury, whereas a reduced notch index has no significant correlation to ACL injury.III.

Objective: To assess the frequency and extent of dilatation of Virchow-Robin (VR) spaces at three levels of the brain in patients of Arab ethnicity in Kuwait recently diagnosed with multiple sclerosis (MS) and compare the results with age- and gender-matched controls. Methods: The magnetic resonance imaging (MRI) scans performed within 3 months of the clinical diagnosis of 80 patients recently diagnosed with active MS were compared to those of 80 age- and gender-matched controls with headache but without any neurological deficits for the frequency and size of VR spaces. MRI was done with noncontrast axial and coronal T1W FSE, axial T2W FSE, axial T2W FLAIR and sagittal FLAIR sequences followed by postcontrast axial and coronal T1W sequences. The frequency of VR spaces in MS patients and controls at midbrain, lenticulostriate vessels and supraventricular levels was analyzed using a two-tailed McNemar test. Results: There was no difference in the frequency of VR spaces at the levels of the midbrain, lenticulostriate vessels and supraventricular white matter between MS patients and controls. In the supraventricular region, however, there were 91 dilated VR spaces in 26 (32%) of the MS patients while in the control group, there were 8 dilated VR spaces in 6 (7.5%) patients and the difference was statistically significant (p < 0.0001). Conclusion: The data showed that dilated VR spaces in the supraventricular region could potentially be used as a marker for MS and as a prognostic tool. However, further studies with a larger population are needed to further evaluate and confirm this observation.

Acute gastrointestinal bleeding (AGIB) is a serious and life-threatening condition. Many diagnostic procedures and tests are being used to detect the site of bleeding with different success rates. The aim of our study is to prospectively evaluate accuracy of 64-slice multi-detector computerised tomography (MDCT) in the diagnosis of lower AGIB.Between September 2007 and January 2009, patients with presumed lower AGIB were referred to the radiology department of our institution for 64-slice MDCT examination as part of the investigation for the lower AGIB. Any abnormalities to account for bleeding, such as tumours, bowel wall enhancement and increased intraluminal density, were recorded.Out of 139 patients with AGIB that were admitted to our casualty department, 27 patients (19 men and 8 women) in the age range of 24-88 years (mean age, 56 years) were suspected to have lower AGIB. Sixty-four-slice MDCT was performed and considered positive for bleeding in 19 (70%) cases, and in all the cases, the bleeding source was indentified in the arterial phase, showing a focal dense wall enhancement in 8 (42%) cases, circumferential wall enhancement in 4 (22%) cases and progressive increasing intraluminal density in 7 (36%) cases. The venous phase scan showed increased dispersion of the contrast within the lumen as an additional clue for active extravasation in 15 (79%) out of the 19 cases. Delayed 5-min scanning showed the same findings as venous phase in all the 19 positive cases and failed to depict any additional findings in the eight cases that were negative on arterial or venous phases.The study supports the high accuracy of 64-slice MDCT in locating the site of AGIB in patients thought to have a distal source of bleeding. Its accuracy in clinically proximal bleeding is not clear from this study, but MDCT is capable of showing such sources.

Background Magnetic resonance imaging (MRI) is of vital importance in the diagnosis and follow-up of patients with multiple sclerosis (MS). Imaging sequences better demonstrating enhancing lesions can help in detecting active MS plaques. Purpose To evaluate the role of fat-saturated gadolinium-enhanced T1-weighted (T1W) images of the brain in MS and to assess the benefit of performing this additional sequence in the detection of enhancing lesions. Material and Methods In a prospective study over a six-month period, 70 consecutive patients with clinically diagnosed MS were enrolled. These constituted 14 male and 56 female patients between the ages of 21 and 44 years. All the patients underwent brain MRIs on a 1.5 Tesla Magnet. Gadolinium-enhanced T1 images with and without fat saturation were compared and results were recorded and analyzed using a conspicuity score and McNemar test. Results There were a total of 157 lesions detected in 70 patients on post-contrast T1W fat-saturated images compared with 139 lesions seen on the post-contrast T1W fast spin-echo (FSE) images. This was because 18 of the lesions (11.5%) were only seen on the fat-saturated images. In addition, 15 lesions were more conspicuous on the fat saturation sequence (9.5%). The total conspicuity score obtained, including all the lesions, was 2.24 +/−0.60 (SD). Using the two-tailed McNemar test for quantitative analysis, the P value obtained was Conclusion T1W fat-saturated gadolinium-enhanced images show better lesion enhancement than T1W images without fat saturation.

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.Methods: A total of 100 consecutive patients suspected of having prostate cancer because of serum PSA > 4 ng/ml, or detection of a prostatic nodule on rectal examination were further investigated by determination of PSAD, TRUS of prostate, sexant prostatic biopsy and histological analysis to establish the correct diagnosis. Other diagnostic measures included the determination of the area under the receiver operating characteristic (ROC) curve, sensitivity and specificity. Results: Of the 100 prostate biopsies that were performed, 33 cases were confirmed to be prostate cancer and 67 were described as benign lesions comprising benign prostatic hyperplasia (BPH) with or without prostatitis. The age range for patients with prostate cancer was 42–90 years, and 52–90 years for those without prostate cancer. The mean prostate volume was 58.82 cc (range 9–177 cc) and 62.60 cc (range 15–140 cc), the mean PSA value was 36.65 ng/ml (range 5.8–200 ng/ml) and 16.49 ng/ml (range 1.4–46.0 ng/ml), while the mean PSAD was 0.92 (range 0.046–5.714) and 0.452 (range 0.034–2.294) for patients with prostate cancer and patients without prostate cancer respectively. Patients with PSA less than 4 ng/ml (3 cases) all had benign prostate lesions, and 7 cases with PSA more than 50 ng/ml all had prostate cancer and were excluded because values above 50 ng/ml have close to 100% specificity for prostate cancer. Further analysis was done on the remaining 90 cases which were patients with a PSA between 4 and 50 ng/ml. The discriminating power of serum PSA for detecting prostate cancer as estimated by the area under ROC was 0.686 while that for PSAD was 0.732. The maximum likelihood for a positive PSA was at a PSAD cut-off point of 0.32. For the PSA cut-off point of l0 ng/ml, the sensitivity was 80%, and specificity was 42.2%. For the PSAD cut-off point of 0.32, the sensitivity was 58% and the specificity 76.6%. Conclusions: Determination of PSAD is not a useful adjunct to serum PSA values in the range of 10–50 ng/ ml in our population. PSAD value less than 0.32 with PSA less than l0 ng/ml strongly suggests benign disease.

Summary Preoperative assessment of the arterial anatomy of prospective renal donors is essential. Various non-invasive techniques are used for such evaluation. We conducted this study using contrast-enhanced 3-D fast-spoiled gradient (CE 3-D FSPGR) magnetic resonance angiography (MRA) on a 1.0 Tesla magnet, for preoperative definition of the renal arteries. Forty-five preoperative living renal donors underwent CE 3-D FSPGR MRA of the renal vessels and the results were compared with conventional digital subtraction angiography (DSA). The renal vascular anatomy, both normal and with variations, was satisfactorily defined in all 45 cases with CE 3-D FSPGR MRA. Fifteen cases showed an accessory or aberrant arterial supply. A small aneurysm was shown in one case. All cases compared well with conventional DSA. Our study revealed that CE 3-D FSPGR MRA on a lower field strength magnet is accurate in defining the renal vascular anatomy and its variations.

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Rheumatoid arthritis (RA) is a common, complex autoimmune disease known to be associated with inheritance of certain human leukocyte antigen (HLA)-DR alleles in different populations. This study investigated the association of DRB1 alleles in Kuwaiti patients with RA.DRB1 alleles were analyzed in 47 Kuwaiti patients and 70 ethnically matched controls using a DNA-based sequence specific primer (SSP) method.The frequency of DRB1*04 allele was higher in patients compared to the controls (P0.012). The association with of HLA-DRB1*04 allele in our patients with RA was accounted for mainly by the seropositive group of patients (P0.05). Moreover, five patients were homozygous for DRB1*4 compared to none in the controls. None of the other DRB1 alleles tested was significantly higher in the patients. All patients homozygous for the DRB1*04 allele were females. There was no statistically significant difference in the frequency of DRB1*04 allele in patients classified according to presence of erosive disease or extra-articular manifestations.Our results indicate that in Kuwaiti patients, RA is associated with the presence of DRB1*04 allele. The lack of association with severity or the phenotype of RA is not surprising since this is a hospital-based study where patients tend to have a more severe disease.

We evaluated the diagnostic accuracy of magnetic resonance cholangiography (MRC) in the diagnosis of bile duct calculi and stenosis. Two-dimensional fast spin echo (FSE) MR cholangiograms were performed using torso multicoil array as a surface coil and respiratory triggering in 50 patients suspected of having bile duct disease. Coronal and axial images were acquired and reviewed prospectively by two radiologists. Direct cholangiographic correlation (endoscopic retrograde cholangiopancreatography [ERCP], intraoperative cholangiogram, percutaneous transhepatic cholangiogram) and surgery were available for comparison and were reviewed by two radiologists. The sensitivity, specificity and accuracy of MRC in diagnosing bile duct dilatation, choledocholithiasis and stenosis were evaluated. It yielded a sensitivity and a specificity of 100% in diagnosing bile duct dilatation. 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 a specificity of 100%. We concluded that MRC exhibited high accuracy in diagnosing bile duct stenosis and choledocholithiasis.