Bone densitometry in patients with rheumatoid arthritis

Rheumatoid arthritis [RA] is a chronic inflammatory disease, with symmetric polyarthritis. There are two types of osteoporosis [OP] associated with RA; periarticular and systemic. Generalized OP in RA patients is believed to be associated with increased production of inflammatory cytokines. The aim of the present work is to evaluate the bone mineral density [BMD] and the frequency of reduced bone mass in RA patients. The influence of different variables related to the patient, the disease and the medications on BMD in RA patients were also assessed. This study was conducted on 100 adult RA patients [88 females and 12 males] and 100 healthy age and sex matched controls. The mean age of patients and controls were 36.11 +/- 9.279 and 35.87 +/- 9.32 years, respectively. The mean disease duration was 5.46 +/- 5.366 years. All the patients were subjected to full history taking, full general and locomotor examination and laboratory investigations. Bone densitometry was performed by dual X-ray absorptiometry equipment in the lumbar spine [LS] femoral neck [FN] and distal third of radius. Two RA groups were analyzed, patients receiving corticosteroids [n= 19] and patients not receiving corticosteroids [n= 81]. At the LS 36% of patients had osteopenia and 9% had osteoporosis compared to 1% of controls had osteopenia [P=0.001], At FN 28% of patients had osteopenia and 3% had osteoporosis while all controls were normal [P=0.001], at radius 24% of patients had osteopenia and 13% had osteoporosis and all the controls were normal [P<0.001]. Considering disease activity, our study showed that DAS 28 is a significant predictor of low BMD by using multilinear regression analysis in both hip [P = 0.049] and radius [P = 0.022], also by Pearson correlation, DAS 28 was found to have negative correlation with BMD at radius [P= 0.023 r = -0.228]. Mean BMD showed no significant differences among corticosteroid users and non users at LS, FN and the radius.[P =0.644, 0.107 and 0.401 respectively], however, cumulative dose of corticosteroids showed significant negative correlation with BMD at hip [P= 0.039 r= - 0.206]. Body mass index [BMI] showed a positive statistically significant correlation with BMD at lumbar spine [r-0.265; P = 0.008] the hip [r- 0.362; P = 0.000] and distal third of radius [r = 0.250; P = 0.012]. There is increased frequency of reduced BMD in RA patients indicating that disease related factors [Rheumatoid factor and Disease activity score DAS 28], as well as patients related factors [age, BMI] and cumulative dose of corticosteroids were found to be associated with the reduction of BMD

Ct and MRI in the evaluation of ventriculo subgaleal technique for CSF diversion

The ventriculo-subgaleal technique for C.S.F. drainage was applied to 60 patients included in this study with acute hydrocephalus of variant etiologies. All patients were evaluated before and after shunt by CT and MRI to assess the degree and cause of hydrocephalus. The value and efficacy of V.SG Drainage Technique was verified both clinically in terms of Glasgow Coma Score in 93.3% and radiologically using the ventricular size index on serial CT scans in 95% of the cases. The V.SG.D replaced the external drainage for periods as long as 3 weeks with no risk of infection and lesser costs. 20% of the patients in this work proved to be shunt independent and V.SG.D has efficiently curved its temporary purpose during the acute phase of hydrocephalus. It also proved its reliability until a definite corrective surgery was performed

Spinal subdural extramedullary masses: myelography, CT myelography and MRI diagnosis

13 conventional myelographic examinations were performed, 7 myelographic CT studies and 4 MRE examinations on 16 cases of subdural extramedullary mass lesions. The lesions were 6 meningioma, 7 neurinoma, 2 lipomas and 1 subdural deposit. The diagnostic criteria of subdural extramedullary mass in myelography, CT myelography and in MRI as well as the differential diagnosis of the different pathological subdural mass lesions were discussed. Subdural extramedullary mass lesions can be easily diagnosed by myelography and CT myelography as well as by MRI. However, MRI has proven to be the procedure of choice in the diagnosis of such lesions

Myelography, CT myelography and MRI of spinal cord lesions: modality evaluation and comparative study

We performed 12 conventional myelographic examinations, 8 secondary CT myelographic studies and 9 MRI examinations on 19 cases having intramedullary lesions. The lesions were 8 ependymoma, 3 astrocytoma, 3 hypdrosyringomyelia, 1 cord contusion, 2 cord arteriovenous malformation and 2 undiagnosed intramedullary lesions. In spite of diagnosis of cord lesion could be reached by myelograhic findings in conjunction with patients clinical picture, MRI has proven to be procedure of choice in the evaluation of suspected cord lesions

ventriculo subgaleal technique: a prolonged temporary aseptic technique for cerebrospinal fluid diversion

Sixty patients with acute hydrocephalus of variant aetiologies constituted the subject of this study. The ventriculo-subgaleal [V.SG.] technique for cerebrospinal fluid drainage was applied to all them. The value and efficacy of this technique was verified both clinically in terms of Glasgow Coma Score in 93.3% and radiologically using the ventricular size index on serial C.T. scans in 95% of the cases. The V. SG. Drainage replaced the external drainage for period as long as 3 weeks with no risk of infection and lesser costs. 20% of the patients in this work proved to be shunt independent and the V.SG. drainage has efficiently curved its temporary purpose during the acute phase of hydrocephalus. It also proved its reliability until a definite corrective surgery was performed. The V.SG. technique for C.S.F. drainage is an easy, safe and aseptic procedure that has been rightly reintroduced to the neurosurgical practice

diagnosis of lesions involving the parapharyngeal space by computed tomography

Lesions arising within or adjacent to the parapharyngeal space present difficulties in their diagnosis as well as in the choice of the ideal surgical approach. The findings on contrast enhanced computed tomography [CT] of 46 patients with lesions in this region are presented. CT can provide reliable informations regarding the size and the extent of the mass lesion, its site of origin, its relationship to the surrounding vascular structures as well as the likely histological type of the lesion in most of cases