Osseous changes in the temporomandibular joint in rheumatoid arthritis: A cone-beam computed tomography study

PURPOSE: To evaluate osseous changes of temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA) using cone-beam computed tomography (CBCT) and to correlate the imaging findings with the severity of TMJ dysfunction, clinical findings, and laboratory findings. MATERIALS AND METHODS: This study consisted of 28 subjects, including 14 RA patients and 14 controls, who were scheduled to undergo CBCT imaging for the diagnosis of a complaint not related to or affecting the TMJ. The Fonseca's questionnaire was used to assess the severity of TMJ dysfunction. Rheumatoid factor (RF) and the erythrocyte sedimentation rate (ESR) were assessed in the RA patients. CBCT was then performed in all subjects and osseous TMJ abnormalities were assessed. RESULTS: According to the Fonseca's questionnaire, 14.3% of the patients had no TMJ dysfunction, while 50%, 21.4%, and 14.3% had mild, moderate, and severe dysfunction, respectively. RF was positive in 64.3% of patients, and the ESR level was high in 100%. Imaging findings revealed a statistically significantly higher prevalence of erosion (85.7%), flattening (89.3%), osteophyte formation (32.1%), subchondral cyst (32.1%), sclerosis (64.3%), and condylar irregularities (28.6%) in the RA patients than in the controls. No correlations were found between CBCT findings and the clinical findings, the severity of TMJ dysfunction, disease duration, or laboratory results. CONCLUSION: RA patients might show extensive osseous abnormalities with no/mild clinical signs or symptoms of TMJ dysfunction that necessitate TMJ imaging for these patients. CBCT is a valuable and efficient modality that can assess osseous TMJ changes in RA patients.

Myocardial preconditioning using sevoflurane inon-pump coronary artery bypass grafting surgery

Anesthetic preconditioning may contribute to the cardio protective effects of sevofiurane in patients having coronary artery bypass surgery. We investigated effects of on- pump exposure to sevofiurane for 10 minutes prior to aortic cross clamping on the hemodynamics, intraoperative ischemia and postoperative biochemical markers for patients undergoing coronary artery bypass. In this pilot study, 40 patients were randomly allocated into 2 groups. Patients of sevofiurane group received sevoflurane4vol.% corresponding to 2 minimum alveolar concentrations for exactly 10 minutes through a vaporizer on the heart-lung machine prior to aortic cross clamping; whereas patients of control group had no further intervention. Myocardial Biomarkers [CK, CK-MB and Troponin I] were measured as markers of cardiac cellular damage. Secondary outcome variables were invasive [systolic blood pressure, diastolic blood pressure, mean arterial pressure, and central venous pressure] and non-mvasive measurements [heart rate], S-T segment changes, diastolic and systolic dysfunctions and wail motion abnormalities in mid-papillary short axis view as well as the four chamber view were assessed by TEE denoting ischemia and finally the need for inotropic support. Hemodynamic parameters showed significant post bypass stability in sevofiurane group [P Value <0.05] compared to the control group, however there were no statistical significant differences between the two groups regarding intraoprative ischemia and inotropic support The myocardial biomarkers 9 hours after discharge to the ICU were comparable between the two groups. Current data demonstrates that sevoflurane-induced preconditioning maintainedhemodynamic stability in the post bypass period; however the preconditioning was without significant effects on intraoperative ischemia or postoperative myocardial biomarkers

Fetal nuchal translucency ultrasound screening for Down syndrome during the first trimester of pregnancy

Down syndrome is the commonest cause of severe mental retardation in children. First trimester screening for nuchal translucency ultrasonographically was performed on 1552 women with singleton pregnancies at 10-14 weeks of gestation. The age of women ranged from 16-43 years. The results showed nine cases with increased thickness of nuchal skin >3 mm with a percentage of [0.58%] of total cases. Seven of these nine cases had abnormal chromosomes by karyotyping [77.78%]. Five cases from the seven cases with abnormal chromosomes had trisomy 21 [Down syndrome] which was [71.4%]. Two women of those who had increased nuchal translucency were euploid. Down syndrome is an age-related disorder. Combination of nuchal translucency ultrasound screening with serum screening is recommended for early diagnosis of Down syndrome in the first trimester of pregnancy

Role of H1 + H2 histamine blocking drugs during morphine anesthesia in open heart surgery

High doses of morphine can produce significant cardiovascular effects generally attributed to histamine release. The authors examined the possibility that H1 and H2 histamine blocking drugs might prove beneficial in preventing this response. In a randomized study, two groups of 10 patients each received 1/mg/kg morphine and either a placebo or diphenhydramine [H1] and cimeidine [H2]. The morphine placebo group demonstrated a decrease in diastolic BP [71 +/- 6 to 59 +/- 5 torr] a decrease in systemic vascular resistance [SVR] [1250 +/- 80 to 950 +/- 70 dyne-sec cm-5] and an increase in cardiac index [CI] [2.6 +/- 0.7 to 3.0 +/- 50 to 1120 +/- 70 dyne-sec cm-5, diastolic BP 7 +/- 6 to 64 torr]. These data demonstrate that significant haemodynamic protection can be obtained by the use of histamine blockings drugs

Haemodynamic changes following cardio pulmonary bypass in mitral and aortic valve replacement under fentanyl anaesthesia

30 patients scheduled for valve replacement were selected, 20 underwent mitral valve replacement and 10 underwent aortic valve replacement under fentanyl anaesthesia. If we consider the haemodynamic changes following the discontinuation of cardio-pulmonary bypass in the mitral group, we find a highly significant drop in pulmonary capillary wedge pressure [PCWP] from 27.1-+6.5 to 18.3-+6, mean pulmonary artery pressure [MPAP] from 37.5-+11.4 for to 27.7-+8.9 systemic vascular resistance [SVR] from 1753.7-+423.3 to 1249-+229.9, highly significant rise in cardiac output [CO] from 3.3-+ 068 to 4.37-+068 and cardiac index [CI] from 2.1-+043 to 2.8-+03.9. In the aortic group no significant changes in the haemodynamic were noted