added value of advanced neuro-imaging [MR diffusion, perfusion and proton spectroscopy] in diagnosis of primary CNS lymphoma

Primary CNS lymphoma is difficult to diagnose with conventional imaging modalities. Magnetic resonance proton spectroscopy, dynamic susceptibility contrast DSC perfusion and diffusion weighted images have been recently investigated as a problem-solving tool for evaluation of primary CNS lymphoma with favorable results. To assess the value of advanced neuro-imaging [MR diffusion, perfusion and proton spectroscopy] in diagnosis of primary CNS lymphoma. Five adult patients with suspected primary CNS lymphoma [as suggested by clinical or conventional imaging techniques] were prospectively studied by magnetic resonance proton spectroscopy, dynamic susceptibility contrast DSC perfusion and diffusion weighted images aiming to confirm the suspected diagnosis. The examinations were done on 1.5T machines using diffusion weighted, dynamic susceptibility contrast perfusion and chemical shift CSI imaging sequences. Regarding DWI, all patients show low ADC value of 0.63 +/- 0.025[SD] x 10[-3] mm[2]/s, regarding the DSC perfusion. The max rCBV ratios are ranging from 0.23 to 1.52 with a mean ratio of 1.14 +/- 0.54[SD]. Regarding

Role of multi-row detector CT enterography in evaluation of small bowel disorders

Imaging diagnosis of small bowel diseases has long been technically challenging. Imaging techniques included plain radiography, contrast studies, computed tomography [CT], magnetic resonance imaging [MRI], sonography, scintigraphy and angiography. Multi-row detector CT [MDCT] enterography is a new technique that improved depiction and characterization of small bowel pathology. To assess the role of multi row detector computed tomography [CT] enterography in evaluation of small bowel disorders. The study was conducted on 30 patients suffering from known or suspected small intestinal disease and subjected to CT enterography using multi-detector row CT and iso-osmotic mannitol as neutral enteric contrast material. CT showed symmetrical mural and mucosal changes in 12 patients, seven of them associated with comb sign and creeping fat sign proved to be Crohn's disease and five patients without specific features due to Crohn's, ulcerative colitis, typhoid colitis, ileitis sequel to complicated appendicitis and typhlitis with ileitis. CT showed symmetrical thickening, grey attenuation pattern and aneurysmal dilatation proved to be lymphoma in three patients. CT showed vascular occlusion and mural changes in two patients. CT showed hyperattenuating lesion in two patients due to bowel wall hematoma, CT showed asymmetrical thickening in four patients, two of them showed infiltrative mesenteric mass with calcifications and desmoplastic reaction proved to be due to carcinoid tumour. One patient with asymmetrical thickening showed strongly enhancing lesion in the enteric phase in the second part of duodenum proved to be periampullary carcinoma. The fourth patient with asymmetrical thickening showed heterogeneous enhancement in the venous at distal heal loop with mesenteric stranding, lymph adenopathy and liver deposit proved to be due to adenocarcinoma. CT showed dilated bowel loops with transitional zone in two patients proved to be due to intestinal obstruction, There were five patients with unremarkable CT features that were followed up without definite lesion. CT enterography with iso-osmotic mannitol is a simple, non invasive, economic, effective method for assessing small bowel disease and can replace other imaging modalities

Effect of core buildup material on the in vitro fracture of crowned endodontically treated teeth

Core buildup materials are used to reconstruct fractured or broken down teeth and to restore endodontically treated teeth. This study was done to determine the effect of core buildup material on the fracture resistance and the mode of failure of endodontically treated teeth restored by all-ceramic crowns. Thirty two extracted intact single rooted second premolars were selected. They were divided equally into four groups and prepared for posts and cores as follows. Group I was prepared for parapost and amalgam core, group II was prepared for parapost and composite core, group III was prepared for cast post and core and group IV [control group] was prepared for parapost and dentin served as a core. Complete crown preparations were prepared. All-ceramic crowns [IPS-Empress] were fabricated and cemented on the prepared teeth. Continuous compressive force was applied to the restored specimens by a mechanical testing machine until failure occurred. The failure load and the mode of failure were recorded. The collected data were analyzed by one-way analysis of variance [ANOVA]. Results revealed that the core buildup material did not affect the fracture resistance of teeth restored by post and cores and pressable IPS-Empress all-ceramic crowns. The mode of failure of the amalgam and composite core system was more favorable to the remaining tooth structure when compared with the cast post and core system

Small diameter partial portacaval shunts SDPPCS: short term efficacy and outcome

Partial portacaval shunts, are distinct in concept and hemodynamics from selective and total shunts. The aim of this work was to evaluate the small diameter partial portacaval shunt operation [DDPPCs] as a definitive management for patients with bleeding esophageal varices from schistosomal hepatic fibrosis and portal hypertension. Thirty-three patients were studied. All patients were prepared for elective partial portacaval shunting using the eight mm. Polytetraflouroethylene [PTFE] Gortex graft. The preoperative work up included full hematological studies, liver and renal function tests, upper Gl endoscopy, with confirmation of variceal grade, abdominal coloured Duplex of the portal [P. V.], splenic [S. V.], and inferior vena cava [I. V.C.], all stigmata of amoniacal encephalopathy were looked for. Fourteen cases [42.42%] were of child's class A, and nineteen [57.57%] were of class B. Oesophageal varices were revealed in all cases with Grades III and IV in 69.69% of cases, and risk signs in 84.84% of cases. The mean diameter [D] of portal vein was 17.3+11 mm. The flow [F] in the portal vein was hepatopetal in all cases with a mean of 2.38+0.64L/minute. All patients after being subjected to SDPPCS operation were followed up for a period that ranged from 15 to 38 months. Postoperative findings, as well as data after one month and one year follow up are presented in this work. The shunt was completed successfully in 30 out of 33 patients, inspite of some operative difficulties which were found in 12 cases. There was no operative mortality. The early mortality rate [30 days after the operation] was 6.06% early thrombosis rate was 9.99%, and late occlusion rate was 3.3%, and rebleeding occurred in 2 cases 6.06%. The varices were down graded in 19 patients and disappeared in 6, while six patients refused follow up endoscopic evaluation. The flow in the shunt was directly visualized in 11 patients with a mean flow of 1.12+0.32 L/Min and 1.73+ 0.26 L/Min one month and one year respectively. The portal vein showed post operative hepatopetal flow that was reduced to 1.59 +/- 0.65 L/Min, and 1.12 +/- 0.51 L/Min one month and one year respectively. This reduction was mainly in the cephalic portion of the vein in comparison to increased flow in the caudal portion. The flow in the I. V.C was increased to 3.2 +/- 0.67 and 3.6 +/- 1.25 post operatively one month and one year postoperatively. There were no cases of hepatic encephalopathy

Renaissance of small diameter partial portacaval shunt: experience, outcome and survival in Egyptian schistosomal portal hypertensive bleeders

The objective of this work was to evaluate specifically the surgical experience, portal haemodynamics, clinical outcome and survival in Egyptian schistosomal portal hypertensive bleeders after the small diameter partial portacaval shunts [SDPPCS]. This prospective study included fifty-six patients out of two hundred and fifty-four patients with schistosomal hepatic fibrosis, portal hypertension, and splenomegaly and complicated by bleeding oesophageal varices. All patients belonged to class A or B of Pugh modification of Child-Turcotte classification of cirrhosis. All patients were studied preoperatively with endoscopy and color duplex. All patients showed a preoperative haemodynamics pattern with hepatopedal flow. The fifty-six patients were prepared for elective small diameter partial portacaval shunt, SDPPCS, using the 8 mm, non-compressible polytetrafluoroethylene [PTFE] graft, Gore-Tex, W. L. Gore and Associates, Inc., Elkton, Md.].Postoperative duplex study was repeated one month, six months, and one year after operation. The portal flow cephalad and caudal to shunt site were measured, shunt patency was directly visualized, and flow in IVC cephalic to shunt in the intrahepatic portion was measured. Postoperative endoscopic evaluation, every three months during the first year, then every six months afterwards, to assess the downgrading of varices. One-three years of follow-up were the time allowed before reporting the final results. The episodes of variceal bleeding, ascites and encephalopathy were recorded for all patients. Twenty-one cases [37.5%] belonged to child s class A, and thirty-five cases [62.5%] were class B. SDPPCS was abandoned in 5/56 [8.9%]. Causes of operative failure in graft replacement were: adhesions due to previous cholecystectomy in 1/56 [1.8%], very thin walled PV in 1/56 [1.8%], very small PV < 10 mm in 3/56 [5.35%], extensive collaterals around the PV in 2/56 [3.58%], and medially displaced PV with inability to dissect a sufficient segment in 1/56 [1.8%]. Complications: were in the form of PV thrombosis in 1/56 [1.8%], IVC thrombosis in 1/56 [1.8%], shunt thrombosis in 2/56 [3.58%], and transected CBD in 1/56 [1.8%]. SDPPCS permitted sufficient volume of prograde flow of portal blood to the liver leading to maintenance of liver functions and low incidence of encephalopathy. SDPPCS resulted in progressive diminution of the size and grade of esophageal and gastric varices, as well as, disappearance of risk signs, thus guarding against rebleeding. There was statistically significant difference in downgrading of esophageal and gastric varices and improvement of gastropathy. SDPPCS resulted in improvement in hematological abnormalities with significant increase of blood elements, especially for thrombocytopenia. SDPPCS resulted in significant decrease in splenic size and splenic congestion. There was no operative mortality. Survival after SDPPCS was 91.07%. Shunt was patent in 49/51 patients [96%]. Three patients [5.357%] complained of mild encephalopathy after SDPPCS. Small diameter partial portacaval shunt [SDPPCS], using 8 mm PTFE graft, is feasible technically and is effective in controlling bleeding esophageal bleeding with preservation of a prograde hepatic portal flow, that preclude encephalopathy, in Egyptian schistosomal portal hypertensive bleeders. It could be considered as an alternative to difficult cases meant for DSRS, or shunt procedures in splenectomized patients

Evaluation of penile vessels in heavy smokers using penile colour duplex

This work aimed to study functional state of penile blood vessels in heavy smokers who smoked more than 40 cigarettes per day for ten years. Fifty-three consented male patients were divided into three groups: Potent non-smokers, potent heavy smokers and impotent heavy smokers. All patients were neurologically and hormonally normal. By a physical examination after intracorporal injection of vasoactive substances, 75.75% of impotent heavy smokers showed no response, tumescence only or uncertain rigidity. There was a statistically significant difference in peak systolic velocity and cavernous artery dilation between potent non-smokers and impotent heavy smokers. Smoking may be considered as a risk factor for erectile dysfunction

Serum type IV collagen concentrations in patients with longstanding essential hypertension

Relation between LS EHT and type IV serum collagen concentration was estimated by RIA. The ACV was estimated from CXR, PA view and it lateral view with barium and RCV was deduced. Twenty-two patients with LS EHT were chosen. Ten normal persons were taken as a control group. Serum collagen concentration and RCV were found to be significantly high in the patients group [P <0.01 and P <0.05, respectively]. A positive correlation was found between serum collagen concentration and RCV [r = 0.97] and another positive correlation was also found between DBP and serum collagen concentration [r = 0.74]. It was concluded that LS EHT has an effect on the capillary basement membrane. It may increase the synthesis, the deposition and the turn over the type IV serum collagen. Serum type IV collagen concentration is a useful noninvasive marker for the activity and progression of hypertension

Transaxillary abdominal and lower limb arteriography the King Abulaziz University Hospital experience

The authors reviewed their experience with 31 patients with transaxillary abdominal and lower limb arteriography; with particular attention to technical difficulty or any complication related to the procedure. The indication/or transaxillary approach were aortic occlusion or stenosis [20/31] common or external iliac occlusion or stenosis [7/31], abdominal aortic aneurysm [2/31], iatrogenic abdominal aortic dissection [1/31] and bilateral femoral artery aneurysm [1/31]. Technical difficulties are minimal using single pigtail catheter technique. Difficulties in catheterization can be overcome by the use of catheter exchange technique and thin safety J guide wire [0.028, 0.025 inch]. Only one patient out of 31 had minimal insignificant axillary haematoma from the procedure. It was concluded that the use of minicatheters [5F] with minimal catheter exchange and adequate manual compression after catheter withdrawal until complete haemostasis minimize the risk of complications

Takayasu's arteritis: angiographic and duplex finding

To our knowledge, this is the first report of Takayasu's arteritis from Arabia. Seven patients out of ten were Saudis. Seven were females and three were males. Chest radiograph is invaluable in the evaluation of this disease since it allows visualization of the contour of the aorta with calcification of aortic wall. Carotid duplex can initially suggest the diagnosis based on characteristic sonogrphic features of the disease, however, panarteriography helps in evaluation of the extent of the disease and the state of collateralization

Role of computed tomography in diagnosis of cerebral infarction

CT study was done to 78 patients presenting with clinical findings suggestive of brain infarction. The CT appearance of brain infarction was found to be dependent on many parameters, mainly the age and stage of the infarction whether initial, developmental or sequellar stage, the location of infarction whether superficial or deep and the size of infarction area whether small or massive. Hypodensity was the most characteristic and most stable CT abnormality of brain infarct. Diminution or disappearance of hypodensity, the fogging effect, occurred during the second and third weeks after the ictus. This phenomenon lasts for few days and may present a great diagnostic difficulty. Contrast enhancement is of utmost importance in detecting cerebral infarction during this period