Temporomandibular joint involvement in rheumatoid arthritis; clinical, tomographic and magnetic resonance imaging study, a new MRI scoring system

The primary objective of this study was to create a new MRI scoring system for assessment of tembromandibular joints [TMJs] arthritic changes in rheumatoid arthritis [RA] based on the precise TMJ tomographic scoring system adopted in 2004[1]. The second aim was to assess the correlation and compare the sensitivity between the new MRI scoring system and the previously established tomographic one. Finally was to correlate the TMJ image findings with the RA clinical disease activity score and disease duration. Twenty RA patients represented forty TMJs were included in the study and recruited from the Rheumatology and Rehabilitation department, Cairo University Hospitals. Full history taking and thorough rheumatologic and intra oral clinical examination were carried out. The patients' disease activity score with three variables [DAS-3]; the Ritchie articular index [RAI], swollen joint count [0-44] and ESR, was recorded. Bilateral TMJ conventional tomography and MRI were done to all patients. Anew MRI scoring system for the severity of TMJ arthritic changes was created based on the TMJ tomographic scoring system[1]. This newly scoring system termed as RA-TMJ-MRI-S states for Rheumatoid Arthritis in TMJ by Magnetic Resonance Imaging Score. The new RA-TMJ-MRI-S not only showed a very high statistical correlation to tomographic scoring system [p = 0.0000] but also demonstrated a respectable sensitivity in early detection of the arthritic changes in TMJ. There was no correlation between the MRI or tomography findings and the DAS-3 or the disease duration. It is recommended to use the new RA-TMJ-MRI-S system; the first MRI scoring system of TMJ that was proved to be superior to the tomographic scoring system, when proper assessment and follow up of the TMJ in RA patients are needed

Color Doppler sonography in assessment of mental artery blood flow

Blood supply of the mandible is an important determinant of the healing process after injury or operation. This fact makes it clear that mandibular hypoperfusion and ischemia are particular problems in the elderly patients and in those who have had radiotherapy. Doppler sonography is widely used to assess blood flow in most major arteries and several of the smaller arteries in the body. Though to our knowledge, its use in the mandible to assess central blood flow has not yet been described. This study was designed to assess the feasibility of using Color Doppler Sonography to evaluate the characteristics of blood flow in the mental artery which would indicate the blood flow in the inferior alveolar artery and to compare between results obtained from control group and that obtained from atherosclerotic patients. Thirty subjects with different ages [22-69 years] were included in this study and comprised two groups; atherosclerotic and control group on whom color Doppler Sonographic examination of the external carotid artery and the mental artery on both sides [Right and Left] was carried out. Results of this study revealed a significant difference between mental and external carotid arteries' indices within the two included groups. Also a significant correlation was proved between mental and external carotid arteries' indices and advancement in age within the two groups. A strong correlation was recorded between mental artery - resistive index and external carotid artery- resistive index within each of the two groups. No wonder that, as the mandibular blood supply is an important factor contributing for many clinical dental problems, its assessment is considered critical in the overall evaluation of healing of the mandible

Comparative study between insufflation and gasless S.E.P.S. techniques

Different techniques have evolved for subfascial endoscopic perforator surgery [SEPS] using either the concept of CO 2 insufflation or the gasless concept. In this prospective comparative randomized study, the gasless technique using a novel space maker self retaining endoscopic viewer [SSEV] was compared with the insufflation SEPS regarding technical simplicity, efficacy and safety. Twenty -four patients [19 males, 5 females] with a mean age of 40 years [range: 26- 54] were randomized between group A [13 patients, 15 limbs] in whom Co, insufflation was used and group B [11 patients, 13 limbs] in whom gasless SEPS technique was chosen with the aid of a space maker self retaining endoscopic viewer [SSEV]. Limb exanguination and tourniquet application was not needed at all in gasless SEPS technique [group B]. Also, space collapse, loss of orientation and abortion of the technique was not encountered. The operative time was shorter than in group A [28 +/- 12 minutes for group A and 15 +/- 9 minutes in group B]. In gasless SEPS, haematoma was not reported. However, mild wound infection and missed perforators were found in 3and2 limbs [23.07% and 15.38% respectively] and ulcer recurrence in 4 limbs [30.76%]. Compared to the insufflalion SEPS technique, the gasless SEPS technique stands as an easier and safer technique with comparable efficiency. Is obviates the need for limb exanguination and the use of tourniquet and keeps the optical field and orientation in the subfascial plane all-through the procedure without collapse or disorientation

Duplex guided endo-luminal radiofrequency ablation of the varicosed great saphenous vein "an old technique using the avalible new technology"

Endo-luminal radiofrequency ablation [RFA] has been proposed as a minimally invasive alternative for treatment of refluxing great saphenous vein. The aim of the study is to evaluate applicability and efficacy of duplex guided endo-luminal radiofrequency ablation of the varicosed. great saphenous vein using the available technology and comparing this with the gold standard treatment. Over two years, forty-three patients with primary great saphenous vein varicosities had been selected and randomly divided info two groups; group A [20 patients, 26 limbs] who were planned for sapheno-femoral disconnection and endoluminal radiofrequency [RP] ablation of their great saphenous vein varicosities and group B [23 patients, 30 limbs] who were subjected to sapheno-femoral disconnection and stripping: The RF ablation in this study using a special catheter was done by open technique through one groin crease incision without intraoperative bleeding, postoperative haematoma or ecchymosis. Thermal skin and saphenous nerve injury and superficial thromb-phlebitis were encountered in 2 limbs [7.69%], clinical and duplex recurrence in 3 limbs [11.54%], and cord like sensation in 6 limbs [23.07%]. Endovenous RF obliteration is more expensive, but the patients recovered faster and had significantly shorter sick leaves [3-7 days] than those in the stripping group [7-15 days]. Endovenous radiofrequency ablation using the available technology is effective in eliminating the great saphenous vein from the venous circulation with faster recovery and better cosmetic results than surgical stripping, yet it is still costy and has some adverse effects

Ultrasound-guided compression of iatrogenic femoral artery pseudoaneurysms

From March 2002 to May 2004, forty-two patients with iatrogenic pseudoaneuiysm after diagnostic and interventional procedures were identified by clinical and duplex examination. Data of the patients were collected regarding, clinical picture, catheterization procedure, size of sheath, coagulation parameters, pseudoaneurysm size and location, time to compression, and number of attempts at compression. Patients who had successful ultrasound guided compression underwent follow-up duplex scanning. Forty-two patients with iatrogenic pseudoaneurysms were treated with UGC over a 26-months period. UGC was successful at obliterating the false aneurysm cavity with the initial attempt in 37 [88.1%] patients, in two of these patients [4.8%] recurrence of false aneurysm occurred 3 and 9 days after initially successful UGC. Obliteration of three additional pseudoaneurysms [7.1%] was achieved on subsequent UGC attempts after failure of the initial attempts of UGC. This account for an overall success rate of [95.3%]. Surgical repair was attempted in two [4.8%] patients where UGC was not successful. There were no episodes of thromboembolism or skin necrosis. Follow-up was available for thirty-six patients, for whom physical examination and follow-up duplex was done 1 to 12 months after compression. There was no evidence of late recurrence of pseudoaneurysm, or residual thrombus. Pseudoaneuiysms after iatrogenic arteriographic and interventional procedures can often be successfully compressed with an ultrasound-guided technique. The precise role of this technique would appear to be a valuable method for management of uncomplicated iatrogenic femoral artery pseudoaneurysms

Skull vault defects reconstruction: comparison of different techniques and results and effect on cerebral hemodynamics: evaluation with transcranial Doppler sonography

The present study is a single-institution prospective clinical and radiological study conducted to evaluate the techniques and results of skull vault defects reconstruction and to investigate changes of cerebral hemodynamics after cranioplasty using transcranial Doppler sonography [TCDS]. All patients underwent clinical and radiological evaluation of their skull defects before and immediately after surgery and at least one year later. The cerebral hemodynamics was examined with TCDS pre-operatively and during the first month postoperatively. The average preoperative defect surface area measured 34 cm2 [range 6-110 cm2]. Skull defects were reconstructed using different methods of cranioplasty. Fifteen patients were repaired with fixed autogenous bone grafts [five cases with rib grafts, five cases with iliac grafts and five cases with split-thickness cranial bone grafts], five cases with acrylic, five cases with titanium mesh and five cases with high-density polyethylene implants [medpor implants]. Regarding follow-up, all patients were monitored a minimum of 12 months with a mean of 21 months. The results and complications were evaluated in relation to each technique. Changes in cerebral blood flow [CBF] were recorded. Before cranioplasty, all the velocities ipsilateral to the cranial defect were significantly low, while in the contralateral side they were near normal. Ipsilateral low cerebral blood flow increased and reached normal levels after cranioplasty. During the follow-up, neurological improvements was observed