Waleed S. Mahafza

Ultrasonographic assessment of splenic volume and its correlation with body parameters in a Jordanian population

Objectives: To estimate normal linear dimensions and volume of spleen in Jordanians using ultrasonography, and to correlate splenic volume with age and body parameters: height, weight, body surface area (BSA), and body mass index (BMI). Methods: A prospective pilot study was conducted on 205 volunteers (115 males and 90 females) not known to have any conditions likely to be associated with splenomegaly. The study was performed at the Radiology Department, Jordanian University Hospital, Amman, Jordan, between December 2013 and August 2014. All linear dimensions of spleen were measured, and splenic volume (index) was calculated using the standard prolate ellipsoid formula (length × width × depth × 0.523). The splenic volume was then analyzed with age and body parameters using the Pearson’s correlation coefficient. Results: The mean (± SD) splenic dimensions were 10.72±1.37 cm in length, 7.40±1.52 cm in width, 4.40±1.47 cm in depth, and 184.15±79.56 cm3 in volume. Men had larger spleens than women (p<0.0001). Age had no significant effect on spleen volume (r=0.11, p=0.12). There was a significant moderate positive correlation (p<0.0001), using Pearson’s correlation coefficient, between the spleen volume, and other parameters (height, weight, BSA, and BMI), with correlation coefficients exceeding 0.3. Conclusion: A local reference of spleen dimensions was established with a different range of values reported previously.

Chronic Gastritis in a Gastric Diverticulum Misdiagnosed as a Left Adrenal Mass

Gastric diverticula are rare and usually asymptomatic. They are most frequently located on the posterior wall of the stomach. Many of them were reported as adrenal masses. Here, we present a 48-year-old male with a gastric fundus diverticulum that was misdiagnosed as a left adrenal mass on magnetic resonance imaging (MRI). Laparoscopic resection of the diverticulum was successfully performed, and histopathological examination revealed a true gastric diverticulum with moderate chronic gastritis. Although most cases of gastric diverticula are asymptomatic, to the best of our knowledge, this is the first reported case of chronic gastritis that developed in a gastric diverticulum.

Objective and subjective improvement in children with idiopathic detrusor overactivity after intravesical botulinum toxin injection: A preliminary report

OBJECTIVE The purpose of this study is to evaluate the effect of Intravesical Botulinum toxin injection on the symptoms and urodynamic parameters in pediatric patients with idiopathic overactive bladder (iOAB) refractory to medical treatment. MATERIALS AND METHODS The study was designed as an open-label uncontrolled therapeutic clinical trial. The eligible patients who underwent Intravesical botulinum toxin injection were evaluated before treatment. The evaluation included a 7-day paper bladder diary to assess OAB symptoms (frequency, urgency urinary incontinence (UUI) and nocturnal enuresis (NE)), filling the Arabic International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI short form), and conducting urodynamic study. The Urodynamic parameters obtained were the maximum filling detrusor pressure, cystometric bladder capacity, and compliance. After 12 weeks of the intravesical injection, the patients were revaluated and the results were compared using paired samples t-test. RESULTS The study enrolled 75 patients. And of those, statistical analysis was done on 46 patients who did follow the study protocols. The mean age was 8.9 years and male to female ratio was 1:4. There was a statistically significant improvement in overactive bladder symptoms and urodynamic parameters in the patient injected with botulinum toxin with minimal side effects. CONCLUSION The evidence in this study would support the safety and efficacy of Intravesical botulinum toxin injection in children with refractory idiopathic OAB with significant improvement of symptoms, quality of life, as well as urodynamic parameters. TYPE OF STUDY Open-label uncontrolled therapeutic clinical trial. LEVEL OF EVIDENCE III.

Diagnosis of mesenteric panniculitis in the multi-detector computed tomography era. Association with malignancy and surgical history

Objectives: To assess the prevalence and associations of mesenteric panniculitis (MP) using multi-detector CT (MDCT). Methods: This retrospective study included 4758 consecutive patients who underwent abdomino-pelvic MDCT between January 2012 and December 2014 at Jordan University Hospital, Amman, Jordan. Radiological database was searched for MP diagnosis and patients with suspected MP were re-evaluated by an experienced radiologist to confirm the diagnosis. Data on all patients with confirmed MP diagnosis were subsequently collected and analyzed. Results: Computed tomography features of MP were identified in 90 patients (41 males, 49 females), a prevalence of 1.9%. Mesenteric panniculitis was identified in both asymptomatic and symptomatic patients. Malignancy was found in 28 MP patients (31%) and 44 of the MP patients (49%) had prior history of abdomino-pelvic surgery. Mesenteric panniculitis was significantly more frequently associated with prior abdomino-pelvic surgery (p=0.0001) and the likelihood of associated malignancy in patients with MP was 2.1-fold higher than in patients without MP (p=0.0013). Conclusion: Mesenteric panniculitis can be reliably diagnosed by MDCT due to its typical CT appearance. Its identification is important because of its significant association with malignancy and because it represents one of the differential diagnoses in patients with nonspecific symptoms referred for abdomino-pelvic CT.

Incidence and anatomical variations of accessory navicular bone in patients with foot pain: A retrospective radiographic analysis

The accessory navicular (AN) is an accessory ossicle anatomically located on the medial side of the foot, proximal to the navicular and continuous with the tibialis posterior tendon. It is occasionally a source of pain and local tenderness. Knowledge of the AN and its morphological variations can help identify the source of a patients symptoms and prevent misinterpreting them as fractures. Foot radiographs from 1,240 patients who presented in two centers with chronic foot pain, or persistent pain developed after trauma, were retrospectively reviewed to determine the incidence and variations of the AN in relation to gender. The AN was found in 20.9% (259/1240). Among 259 feet with AN, Type 1 was identified in 25.4% (66/259), Type 2 in 42.4% (110/259) (20.0% (52/259) Type 2 A and 22.4% (58/259) Type 2B), and Type 3 in 32.0% (83/259). After 13 patients with incomplete medical records had been excluded, the remaining records showed that foot pain was associated with an AN in 10.6% of patients (26/246). In 1.2% of cases, two additional ossicles were found proximal to the navicular, possibly the result of multiple ossification centers that did not unite at the time of development. Patient symptomatology was related to the presence of an AN in 2% of patients with chronic foot pain. The AN could vary morphologically. Our data can enhance our diagnostic skills in detecting these ossicles. Clin. Anat. 30:436–444, 2017.

Testicular microlithiasis: Correlation with doppler sonography of testicular arteries and sperm function.

To determine the prevalence of testicular microlithiasis and its correlation with Doppler parameters of testicular arteries and sperm function.

Evaluation of Normal Appendix in Adult Jordanians Using Non-Enhanced Dual Source 64-Slice MDCT = تقييم الزائدة الدودية الطبيعية عند الأردنيين البالغين باستخدام الطبقي المحوي

Objective: To evaluate the frequency of visualization and size measurements of normal appendix in Jordanian adultsusing non-enhanced dual source 64-slice multidetector computed tomography (MDCT). Materials and Methods: A retrospective review of 240 consecutive adult patients (150 men and 90 women, age range 18-86 years, mean age = 49.8) who underwent a non-enhanced abdominal CT for possible renal stone disease was conducted. A senior radiologist interpreted the images in the axial, coronal, and sagittal planes. The visualization, location, contents, maximum outer diameter and two wall thickness of visualized appendices were recorded. Results: The appendix was visualized in 95% of patients. Intraluminal contents were identified in 70.6% of patients. The greatest outer diameter of the appendix ranged between 4 and 11.4 mm (mean= 6.2 mm), and the two wall thickness ranged between 1.8 and 7 mm (mean = 5.4 mm). The prevalence of appendicitis in this study was 7.8%. Conclusions: Non enhanced MDCT is extremely useful in identification of normal appendix. The conspicuity and detection rate of normal appendix were significantly improved when additional multiplanar reformation images, particularly coronal images, were used. The wide variation in the outer diameter of normal appendix on CT may lead to significant overlap between normal and abnormal appendix, therefore, to reduce the false positive and false negative diagnoses of acute appendicitis other secondary signs should be recruited.