Extensive aortic dissection: role of CT angiography in diagnosis and planning of management

To evaluate the role of CT angiography in the diagnosis and management planning of suspected cases of aortic dissection. Retrospctive study. Department of Radiology, Al Khor Hospital, Qatar. Aortic dissection [AD] is characterized by the splitting of the aortic wall by high-pressure arterial blood entering the media through an intimo-medial entrance tear. Aortic disease contributes an emerging share of the burden of cardiovascular disease. AD is the most frequent cause of aortic emergency, unless it is diagnosed rapidly, and treated, results in death. Two patients with suspected aortic dissection, presenting to the emergency department, underwent CT angiography. This was done using dedicated aortic protocol for which time delay, for enhanced scanning, was achieved using bolus tracking with region of interest on descending thoracic aorta. Retrospective analysis of the images was performed by two radiologists to evaluate findings pertinent to diagnosis and further management planning. The inter-observer agreement in the diagnosis and CT findings of both the cases was 100%. Two male patients aged 37 and 58 years were included in this study. CT angiography images characterized: Type of dissection -one Stanford A [Case1] and the other Stanford B [Case 2]; differentiated true from false lumen- both cases; located entry tear [Case 1]; located branch vessel origin and involvements-both cases; Type of branch vessel occlusion: static or dynamic [Case1] and complications like medaistinal hematoma with dissection into left pulmonary artery sheath [Case2], acute intramural hematoma [Case2], and renal infract [Case1]. CT angiography for suspected aortic dissection not only diagnoses the condition but also gives relevant details for planning of management

Efficacy of arthrocentesis, splint therapy and MRI assessment in management of patients with temporomandibular joint disorders

To evaluate clinical biochemical and imaging assessment of the efficacy of lavage [arthrocentesis] of proinflammatory cytokines in the synovial fluid in symptomatic TMJ with or without the use of anterior repositioning splint. Radiodiagnosis Department. Faculty of Medicine, Alexandria University, Maxillofacial surgery, Prosthodentics and Oral surgery Departments, Faculty of Dentistry, Alexandria University. 20 patients [12 females and 8 males] with symptoms of TMJ pain, joint noise, limitation of joint opening, tenderness located in the articular region. all patients underwent full clinical examination and diagnostic imaging [panoramic radiographs] and MRI. patients were grouped into two; [group I] those treated by arthrocentesis of TMJ [the proinflammatory cytokines alone] and [group 2] those were treated by arthrocentesis and anterior repositioning splint therapy. arthrocentesis were done two times with interval of 6 weeks. MRI were done before treatment and after two months from treatment. the patients were divided into two groups both groups were treated with anhrocenzesis mandibular hard acrylic resin repositioning splint constructed for group 2 and was worn after arthrocentesis. clinical, biochemical and radiological imaging [MRI] evaluations were carried out to assess the efficacy of arthrocentesis [lavage] of the inflammatory cytokines in the synovial fluid of the symptomatic TMJ disc position and erosions can be fully assessed by MRI and both groups demonstrated marked clinical improvements after treatment mainly of group 2 and this match with the improvement of the disc position identified by MRI. patients with disc erosions were the least to improve. 1. the combination treatment of arthrocentesis of TMJ and mandibular repositioning splint give the advantages of pain relief and considered as the treatment modality of choice before surgical intervention to avoid the morbidity associated with surgery. 2. MRI is the only direct objective, very sensitive and accurate imaging modility to test the validity and effect as well as the prognosis of lavage [arthrocentesis] and prothesis treatment [splint therapy] of TMJ disorders. 3. erosion of the disc is a sign of bad omen in the way of anatomical repositioning of the disc after different modalities of treatment

surgical management of ambiguous genitalia secondary to congenital adrenal hyperplasia Alexandria experience

Congenital adrenal hyperplasia is the most common cause of female pseudohermaphroditism all-over the world. The excessive androgenic intermediates released by the diseased adrenal gland virilize the external female genitalia during the early in-utero life to a variable degree. Medical treatment is mandatory to correct the life-threatening metabolic derangement leading to salt-losing crises and surgical correction of the genitalia is essential for the psychologic and functional integrity of the female patient We operated on 12 girls with CAH to correct their genitalia. The surgical procedure included: [1]. after complete degloving of the hypertrophied phallus, mobilization of the roots of the corpora to their attachment at the pubic arch. The neurovascular bundle is dissected and preserved to keep supply of the glans. The corporal bodies are dissected from their attachment to the pubic bone to their termination at the glans. Adequate hemostasis is performed and the glans is fixed with sutures to the roots of the corpora. [2]. A posterior perineal flap is fashioned by drawing an inverted u incision centered on anal verge and reaching to the posterior limit of urogenital sinus anteriorly. [3]. the skin of the phallus, after degloving, is used for replacing the labia minora after division in the midline. The results of this operative procedure proved very effective with excellent cosmetic appearance of the genitalia and good vaginal patency in all the cases followed-up for three years. Mild vaginal stenosis was encountered only in three girls but none had tight stenosis. In conclusion, our data proved that complete correction in one stage is the treatment of choice. Reduction clitoroplasty is the best procedure for the treatment of phallic enlargement. Posterior perineal flap vaginoplasty is highly successful in preventing later vaginal stenosis. However, regular follow up is recommended for calibration and dilatation of the vagina and adjustment of the doses of steroid to assure good suppression of adrenal androgens in these girls

effect of two designs of overdenture on bone density of mandibular alveolar supporting structures using computed tomography

This study evaluated the effect of the design of overdenture on the bone mineral content of the mandibular alveolar bone around the remaining abutment teeth. Six female subjects who made two groups were selected, each received maxillary complete denture opposed by mandibular overdenture. Conventional designs of overdenture were used for the first group, metal dowels, copings for the remaining canines and for the second group cast dowels and copings with tissue bar in between were utilized for the mandibular overdenture. Measurements of bone density were performed at two sites of each canine [mid-root and apex] using computed tomography immediately after insertion of overdentures and 6 months later. The comparison of each site between the first measurement and the 6 months later measurement revealed increase in bone density value, but not statistically significant. Comparison of the mean of each group [representing all sites together] before and after 6-month period showed no statistical significance in the bone density for conventional design group at both sites and a statistical significant increase in bone density for the tissue-bar design group at both sites. Quantitative computed tomography seemed to be a reliable and adaptable technique for bone density measurement which can help in predicting the rate of change in the alveolar bone