Frequency of low bone mineral density in Saudi patients with inflammatory bowel disease.

BACKGROUND/AIMS: Metabolic bone disease is common in patients with inflammatory bowel disease (IBD). Our aim was to determine the frequency of bone loss among Saudi patients with IBD and possible contributing risk factors. SETTINGS AND DESIGN: We retrospectively reviewed Saudi patients with IBD, between 18 and 70 years of age, who had bone mass density (BMD) determined by dual-energy X-ray absorptiometry scanning at one of three hospitals in the Kingdom of Saudi Arabia from 2001 to 2008. PATIENTS AND METHODS: Case notes and BMDs results were carefully reviewed for demographic and clinical data. Low bone mass, osteopenia, and osteoporosis were defined according to the WHO guidelines. STATISTICAL ANALYSIS USED: Predictive factors for BMD were analyzed using group comparisons and stepwise regression analyses. RESULTS: Ninety-five patients were included; 46% had Crohn's disease (CD) and 54% had ulcerative colitis (UC). The average age was 30.9±11.6 years. Using T-scores, the frequency of osteopenia was 44.2%, and the frequency of osteoporosis was 30.5% at both lumbar spine and proximal femur. Only 25.3% of patients exhibited a BMD within the normal range. Our results revealed a positive correlation between the Z-score in both the lumbar spine and the proximal femur and body mass index (BMI) (P=0.042 and P=0.018, respectively). On regression analysis BMI, age, and calcium supplementation were found to be the most important independent predictors of BMD. CONCLUSIONS: Saudi patients with IBD are at an increased risk of low BMD and the frequency of decreased BMD in Saudi patients with CD and UC were similar. BMI and age were the most important independent predictors of low BMD.

Magnetic resonance imaging of pelvic and femoral bones for detection of bone marrow infiltration in patients with non-Hodgkins lymphoma.

OBJECTIVE: Detection of the residual bone marrow (BM) involvement is essential in treatment of patients with non-Hodgkin's lymphoma (NHL). Bilateral iliac crest BM biopsies appear to have low sensitivity for BM infiltration, while magnetic resonance imaging (MRI) presents more global view of BM. This study was conducted to determine the advantage of femoral marrow MRI as a non-invasive technique over bilateral iliac crest BM biopsies in detecting BM infiltration before treatment and residual disease after completion of treatment. METHODS: Over a period of 27 months from January 2002 to March 2004, a total of 30 patients with newly diagnosed NHL were included in the study. Magnetic resonance imaging of 26 patients were conducted in King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia. Magnetic resonance imaging of 4 patients were referred from different hospitals in the Eastern Province. Twenty-five patients were of B-cell type and 5 patients were of T-cell type. Coronal MRI of the pelvis and femoral marrow were obtained by the T1, T2-weighted spin echo sequences and short TI inversion recovery technique. RESULTS: Magnetic resonance images showed BM infiltration in 17 cases (56.7%) before treatment and positive biopsy results were found in 9 cases (30%); all had abnormal MR images. There was a significant difference between both methods in the detection of infiltration (p=0.037). Magnetic resonance imaging showed that 58.8% of cases have scattered pattern, 23.5% were uniform and 17.6% of cases have nodular patterns. Magnetic resonance images after completion of treatment showed residual BM infiltration in 6 out of 17 cases who previously had positive MR images and only one case of them had a positive BM biopsy with a significant difference between both methods and all of them relapsed within 6 months (p=0.034). CONCLUSION: Magnetic resonance images of the pelvis and femoral marrow were superior than BM biopsy on detection of BM infiltration before treatment and residual infiltration after treatment.

Bone mineral density among postmenopausal Saudi women.

OBJECTIVE: Osteoporosis is reported to be common among postmenopausal Saudi women. The reported incidence varies between 50-60%. Different machines were used to reach these conclusions. At present it is believed that dual energy x-ray absorptiometry (DEXA) is the most accurate method to diagnose osteoporosis. This study was conducted to measure bone mineral density (BMD) measurement of lumbar spine and the upper femur of Saudi postmenopausal women attending orthopedic clinic with unrelated complaints. METHODS: This study comprises of 256 patients attending orthopedic clinics at the King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia between January 2002 and June 2003. The data gathered was age, duration of menopause, height and weight for body mass index (BMI) calculation. Women with secondary osteoporosis were excluded from the study. Patients' orthopedic complaints were also recorded in the database. Bone mineral density measurements were carried out using Hologic total body DEXA machine. The data were analyzed using SPSS package. RESULTS: The data of 256 patients was available for analysis. The average age of patients screened was 57.62 years (49-76) SD +/- 6.71. The BMI was 21.3-42.9 Kg/m2 (SD +/- 5.34). The BMD of the lumbar spine was 0.785 gm/cm2 (0.527-1.023) SD +/-0.142 and that of the hip region was 0.764 gm/cm2 (0. 500-1.069) SD +/- 0.149. As per the WHO classification 59 women (23%) were classified as normal with T score of -0.82, 78 (30.5%) as osteopenic with T score -2.5 and 119 (46.7%) as osteoporosis with T score -3.58. When the BMD of the hip was analyzed 62 (24.2%) were normal T score -1.0, 81 (31.6%) as osteopenic, T score -2.5 and 113 (44.1%) as osteoporotic, with a T score of -3.1. On the basis of analysis of the lumbar spine 190 (74.2%) had increased risk of fracture as compared to the analysis of hip 59% were at increased risk of fracture. CONCLUSION: Our results indicate that postmenopausal Saudi women suffer from osteoporosis and osteopenia higher than those from other parts of the country. Necessary steps are needed so as to avoid osteoporosis and its complications which could end up in epidemic proportions.

Dramatic vascular course of Behcet's disease.

Vascular involvement in Behcet's disease is rare approximately 14% venous and 1.6% arterial, serious and recurrent. We report a case of Behcet's disease with deep venous thrombosis and right iliac pseudoaneurysm which was repaired with polytetrafluoroethylene PTFE graft. The patient received warfarin, aspirin, clopidogrel, immunosuppressive and corticosteroids. Two months later the patient developed manifestations of superior vena cava thrombosis and the graft was blocked. Three months later, ischemia of the right foot deteriorated and left femoral artery to right femoral artery crossover PTFE graft was performed.

Mesenteric cystic teratoma in children.

Mesenteric teratoma is an extremely rare tumor, arising, akin all other teratomas, from totipotent primordial cells and displays a mixture of tissues of tridermal or bidermal origin. Two cases of mature mesenteric teratoma in a 5-month-old girl and a 4-month-old boy, the youngest reported in the literature, excluding a case recently diagnosed prenatally, are described. Diagnostic tools, differential diagnosis and management are also discussed.

Thyroid tuberculosis mimicking carcinoma: report of two cases.

Among 527 patients with thyroid disease who underwent surgery at our hospital during a 20-year period, 2 (0.4%) had tuberculous thyroiditis mimicking carcinoma. The first patient was a 44-year-old man with a solitary thyroid nodule and the second was a 24-year old man with a thyroid abscess. The unexpected diagnosis was made postoperatively and was based on histological findings in both patients. No primary focus was found elsewhere in either patient, and both responded to antituberculous chemotherapy. Although the diagnosis is usually based on examination of resected specimens, recent reports indicate that find-needle aspiration cytology is a cost-effective technique of diagnosing thyroid tuberculosis. A review of 35 cases reported in the English literature is also discussed.

Clinical prediction rule for pulmonary infiltrates.

Full text is available as a scanned copy of the original print version.