Dermatomal somatosensory evoked potentials in evaluation of lumbosacral spinal canal stenosis

To evaluate Dermatomal Somatosensory evoked potentials [DSEPs] as an objective test for detection of sensory compromise and segmental affection of sensory roots in lumbar spinal canal stenosis. 25 patients with LSSS and candidate for decompressive surgery were recruited for the study. They were diagnosed by clinical and radiological criteria. 10 healthy subjects were concluded as a control group. SEPs and DSEPs were done preoperatively and 3 months postoperatively. There was a significant difference between patients and controls as regard DSEPs latencies [p<0.05] while there was no significant difference between the two groups as regard DSEPs amplitudes. There was statistically significant difference between preoperative and 3 month postoperative DSEPs latencies [p<0.05]. There was statistically significant difference between preoperative and postoperative functional scores [p<0.05]. Sensitivity of DSEPs was 92%.The results of this study showed that DSEPs is a sensitive test and complementary to the radiological investigations providing information about the electrophysiological function of lumbosacral roots and the level of root compression. It is also non-invasive easy test

Value of dexamethasoneiontophopresis vs. local injection of dexamethasone in the treatment of plantar fasciitis

To evaluate the effect of dexamethasone [DXM] iontophoresis in treating plantar fasciitis compared to the effect of local DXM injection. The study was performed on 21 patients [26 feet] complaining of plantar fasciitis of at least 2 months duration. Patients were selected on the basis of their clinical presentation and confirmed by plain Xray and diagnostic ultrasonography. Patients were classified into 2 groups: Group I [11 patients] received 10 sessions of iontophoresis using solution of 0.4% DXM on alternating days, while Group Ii [10 patients] received one local steroid injection of DXM into the area of maximum tenderness. Reassessment of the patients of both groups was done 3 weeks after starting their treatment program by assessment of pain intensity using numerical visual analogue scale [VAS], assessment of tenderness using Heel Tenderness Index [HTI] and ultrasonography examination. There was high statistical significant improvement of in all patients of group I, and in 7 patients of group II. Two feet had steroid flare in group II. No difference of statistical significance between the 2 groups was detected regarding change in HTJ, or change in ultrasound findings. However, there was a statistical significance difference regarding decrease in pain intensity with higher improvement in group I. Dexamethasone is an effective anti-inflammatory drug in treating plantar fasciitis whether applied by iontophoresis or by local injection. However, lontophoresis has the advantages of painless application with no risk of infection or fascial rupture

Correlation of serum level of homing cell adhesion molecule [HCAM, sCD44] with clinical features and prognosis in systemic sclerosis

To evaluate the level of Homing Cell Adhesion molecule [H-CAM, sCD44] in the sera of systemic sclerosis [SSc] patients and to investigate its relationship to clinical and prognostic features of the disease. This prospective study was conducted on 30 SSc patients; 18 with limited cutaneous SSc [lSSc] and 12 with diffuse cutaneous SSc [dSSc]. Twenty apparently healthy subjects participated to the study as controls. Clinical evaluation and pulmonary function tests were done for all of them. Laboratory investigations and serum levels of soluble CD44 [sCD44] were determined using specific enzyme-linked immunosorbent assay [ELISA] for all patients and controls. Serum concentration of sCD44 was significantly elevated in SSc patients as compared with controls [1.89 +/- 0.72 vs. 1.42 +/- 0.33 ng/ml, p<0.001]. This elevation was observed in 43% of SSc patients; in 50% with lSSc patients but only 33% in dSSc patients. In addition, serum sCD44 levels were significantly elevated in patients with lSSc when compared with those with dSSc patients and both were significantly higher than controls [2.06 +/- 0.62 vs. 1.67 +/- 0.25 ng/ml, p < 0.001 and p < 0.02 respectively]. A significant correlation was found between elevated sCD44 levels and the extent of skin sclerosis as determined with Modified Rodnan Skin Score [r=0.670 and p<0.001]. It was also found that the prevalence of pulmonary fibrosis and decreased FVC% and FEV1% in SSc patients with elevated sCD44 levels were significantly lower than in those with normal sCD44 levels [15 vs. 51%, p <0.001; 16 vs. 56%, p <0.001 and 28 vs. 64%, p<0.001 respectively]. Furthermore, the prevalence of pulmonary fibrosis was significantly lower in ISSc with elevated sCD44 levels than in those with normal levels [22% vs. 56%, p<0.001]. Although the disease duration was similar for SSc patients with elevated sCD44 levels and those with normal levels, the disease duration in ISSc patients with elevated sCD44 levels was significantly shorter than in patients with normal sCD44 levels [4.1 +/- 6.6 vs. 7.1 +/- 9.4 yrs; p<0.01]. Elevation of serum concentration of sCD44 and its prevalence was more in the limited form of SSc [ISSc]. This elevation correlated significantly with the shorter disease duration in patients with ISSc. Furthermore, elevated sCD44 levels were also associated with lower prevalence of pulmonary involvement and better pulmonary function in SSc patients. This was observed even in patients with ISSc. Taken together, these results suggest that the elevation of sCD44 may be a prognostic marker and protective factor for the development of skin sclerosis and pulmonary fibrosis in SSc

Non-invasive assessment of endothelial dysfunction in pre-menopausal systemic lupus erythematosus women at risk of atherosclerosis

To assess the endothelial dysfunction in patients with SLE by measuring endothelial reactivity in pre-menopausal female patients at risk of atherosclerosis without traditional cardiovascular risk factors. This study was conducted on 30 pre-menopause SLE patients and 25 age and sex- matched volunteers. All the patients and controls were free of traditional cardiovascular risk factors. We examined the endothelial function by brachial artery FMV, assessed by high resolution non-invasive ultrasound, where the diameter of the brachial artery is measured at rest and after reactive hyperaemia. The FMV of the brachial artery [endothelium dependent response] was significantly lower in patients than in control subjects [4.1 +/- 1.3 v13.2 +/- 2.0%; p<0.001]. Comparing the FMV with the different variables of the patients' group, we did not find any significant correlation between FMV and; patients' age, disease duration, systolic and diastolic blood pressure, Raynaud's phenomenon, vasculitis and ESR. While, there was a strongly significant difference in brachial artery FMV seen between 12 [40%] aCL positive patients compared to 18 [60%] patients with aCL negative and when compared with controls [4.0 +/- 0.7 v 11.3 +/- 0.6]%, p <0.001; 4.0 +/- 0.7 v 13.2 +/- 2.0%, p<0.001 respectively]. There was also a strongly positive correlation between SLEDAI disease activity score and baseline diameter and FMV [rs=0.42, p<0.001; rs= 0.44, p<0.001 respectively]. While there was a weakly positive statistical difference between FMV and the CRP [rs=-0.24, p=0.05]. The baseline value of FMV showed an inverse correlation with LDL cholesterol [r = -0.41, p<0.05]. When we compared the patients who had received corticosteroids, antimalarial, methotrexate and other medications with those who had not, we didn't find a significant statistical difference concerning the FMV. This study demonstrated that pre-menopausal patients with SLE free from cardiovascular risk factors and overt CVD have an altered endothelial reactivity which correlates positively with a CL positive subgroup of patients, SLEDAI disease activity score, serum CRP values, along with high LDL cholesterol concentration. This endothelial dysfunction indicates a higher susceptibility to the development of atherosclerotic disease

Anti-neutrophil cytoplasmic antibodies in juvenile chronic arthritis and rheumatoid arthritis

To assess the incidence and clinical significance of ANCA in RA and JCA patients, and to study the relation between ANCA and granulocyte specific ANA. Serum antineutrophil cytoplasmic antibodies were determined with indirect immunofluoresescent [IIF] technique in 20 RA and 12 JCA patients. ANCA was detected in sera from 10 RA patients [50%] and their titer ranged from 110-350 and JCA patients [25%], their titer ranged from 70-230. ANCA titer was not correlated with RF, disease duration and the presence of ANA. p-ANCA were found in 25% RA patients and 8% of JCA patients, c- ANCA were seen in 25% of RA patients and 17% of JCA patients. The laboratory and histologically proven nephropathy were seen in 25% of RA patients 8% of JCA patients, they were associated with p- ANCA. We concluded that early diagnosis of ANCA associated vasculitides is a key to prevent renal failure, and to measure the serum ANCA titer not only for the diagnosis the clinical course, but also to early treatment of renal affection

Role of ultrasonography in the diagnosis and management of plantar fasciitis

To evaluate the sonographic features of plantar fasciitis and to investigate the efficacy of ultrasound-guided local steroid injection in its management. Forty patients, aged 25-55 years who had a clinical diagnosis of plantar fasciitis, 1-3 years previously and twenty age-matched healthy volunteers [control group], were evaluated with conventional x-rays then with ultrasound using a 7.0 MHZ linear-array transducer. All patients had calcaneal spurs in their X-rays. Heel pain was unilateral in 24 patients and bilateral in 16. Sagittal sonograms were obtained, and the thickness of plantar fascia was measured at its proximal end near its insertion into the calcaneus. Other findings including hypoechoic fascia, fiber rupture, perifascial fluid collections and calcifications were searched for. Evaluations were performed before, at 2 weeks and 3 months after a single dose of ultrasound-guided local steroid [7 mg Betamethasone and 0.5ml of 1% lidocaine] injection into the inflamed plantar fascia. Pain intensity was quantified with a tenderness threshold [TT] and visual analog scale [VAS]. Plantar fascia thickness was significantly increased in heels of patients with plantar fasciitis [mean 3.91 +/- 0.53] as compared to control [mean 2.13 +/- 0.18] [p<0.0005]. The mean thickness of the plantar fascia had decreased significantly on evaluation after 2 weeks [mean 3.73 +/- 0.53] [p<0.05]. While after 3 months there was a highly significant decrease [mean 2.39 +/- 0.43] [p<0.0005]. The mean VAS score and TT showed a highly significant improvement on evaluation after 2 weeks and 3 months [mean 4.57 +/- 0.98, 1.55 +/- 0.84 and 7.12 +/- 0.75, 9.47 +/- 1.66 respectively, p<0.0005]. The comparison between the second and third evaluations of all our parameters showed a highly significant improvement [p<0.0005]. The proximal plantar fascia was diffusely hypoechoic as compared to controls. No fascial rupture, perifascial fluid collection or calcifications were identified. Increased thickness of the fascia and hypoechoic fascia are sonographic findings of plantar fasciitis. Sonography provides sufficient information for the physician to confirm an initial diagnosis of plantar fasciitis and assess individual treatment regimens

association between rheumatoid arthritis and hepatitis C virus infection

To study the association between rheumatoid arthritis and HCV infection. The study included 40 RA patients diagnosed according to the ACR criteria [group I]. It also included 20 inflammatory arthritis patients with RF positive but not fulfilling the criteria for diagnosis of RA [group II]. Ten age and sex matched subjects were taken as controls. Anti HCV antibodies were detected in the sera of these patients. 0.5% of the patients of group I had anti HCV antibodies while 20% of patients of group II had anti HCV antibodies. As regards the control group, none was anti HCV antibody positive. There is a strong association between the presence of anti HCV antibodies and rheumatoid factor that is stronger than the association between anti HCV antibodies and rheumatoid arthritis. Patients with anti HCV antibodies may have rheumatoid factor positive in their serum, but the picture may not fulfill the criteria of RA. Thus in any case of inflammatory arthritis, hepatitis C virus must be put in consideration

Treatment of chronic rotator-cuff impingement with arthroscopic subacromial decompression

We made a prospective study on 29 patients who had arthroscopic subacromial decompression for chronic rotator-cuff impingement. All patients were diagnosed as having chronic rotator-cuff impingement on the basis of clinical and sonographic examination. All patients were assessed pre-operatively and at 3, 6 and 12 months post-operatively using the shoulder-rating scale of the University of California at Los Angeles [UCLA]. The dominant arm was affected in 24 patients. There were 26 males and only three females. Before operation, the UCLA shoulder score was poor or fair in all patients. After three months of the operation 48% of patients had satisfactory relief of symptoms but at one year 93% of patients examined had a good or excellent result We concluded that arthroscopic subacromial decompression is an effective form of treatment, but full recovery of function and relief of symptoms could take long time