Lumbar facet joint block: computed tomography guided technique compared with fluoroscopy guided technique using the posterior approach: a comparative study

Facet joint is a main source of chronic low back pain with a prevalence of 16.7%. Clinical examination and imaging are insufficient to diagnose facet joint syndrome [30% accuracy and 45% false positives]. Facet joint block is the gold standard in diagnosis of facet joint syndrome. It can also relieve pain for up to 6 months. It can be done under computed tomography [CT] or fluoroscopy. To identify which imaging modality is more suitable to guide the procedure of lumbar facet joint block, fluoroscopy or CT. Thirty four lumbar facet joints represented by 12 patients were injected in the radiology department, Suez Canal University Hospital, Ismailia, Egypt from 1/2005 to 1/2006. All cases were suspected of having facet joint syndrome based on clinical or radiological data. After clinical examination and reviewing lumbar images to identify target facets, every patient underwent facet joint block under either CT or fluoroscopy. Fluoroscopy was more successful in guiding the injections [success rate 77.7% compared with 31.25% in CT guidance]. It is also faster [6.6 minutes per joint compared with 10.9 minutes for CT guidance]. Less number of trials were required [1.7 trial compared with 6.6 trials with CT guidance]. Fluoroscopy exposed the patients and the radiologist to much irradiation [21.3 rad compared to 0.3 rad in CT guidance]. Decreased bone density and laminectomy impair fluoroscopy guidance. CT guidance is difficult in patients with marked arthropathy and coronally oriented joints [8 trials compared with 5.6 for normally appearing joints]. Fluoroscopy should be the primary choice for guiding lumbar facet joint block. It is more successful and faster. Its disadvantages include much irradiation to patients and radiologists, and difficulty in patients with laminectomy and decreased bone density. CT can then be used to guide the block

Role of two-dimensional computed tomography, multiplanar reconstruction and three dimensional computed tomography in the assessment of facial trauma

Computed tomography [CT] has become the primary imaging modality for diagnosis of facial fractures. Spiral CT further simplified diagnosis of facial trauma by allowing multiplanar reformations and three dimensional reconstructions while reducing patient motion and registration artifacts.To evaluate the role of helical CT and three dimensional reconstructions in diagnosis of different patterns of facial fractures. From June 2003 to February 2005, One hundred patients aging from 6-64 years [including 78 males and 22 females] presented with a variety of facial injuries were included in the study. All patients were referred to our CT unit from the emergency department, Suez Canal University Hospital, Ismailia. All cases underwent a spiral CT study then, the image data were manipulated and analyzed. Fracture detection by two dimensional computed tomography [2D CT] and multiplanar reconstruction [MPR] together was 100% [226 of 226 fractures], fracture detection by axial 2D CT alone was 220 of 226 fractures [97.3%] but fracture detection by 3D CT alone was 183 of 226 fractures [80.9%]. Two cases of cribriform plate of ethmoidal bone fracture, one case of nasal septum fracture, one case of hard palate fracture, one case of orbital roof and one case with orbital floor fracture was done by coronal reformatted images and missed on axial 2D CT images. MPR was useful or determinant in 53 of 226 fractures [23.4%] of all fractures in comparison with direct axial 2D CT. Three dimensional computed tomography [3D CT] images alone never showed any more fractures than those seen on axial and coronal-reformatted images. Fracture detection was always superior by 2D CT but perception of fragment displacement and resulting disruption of facial symmetry was superior on 3D CT. The greatest advantage of multiplanar imaging is the improved depiction of skeletal injuries along a horizontal plane, paralleling that of axial scans. The depiction of fractures of cribriform plate of ethmoidal bone and orbital roof and floor was particularly useful from a clinical viewpoint. 3D CT images should be used as a useful complementary tool

Evaluation of multiple transrectal ultrasound guided biopsies of the prostate for the detection of prostate cancer

To evaluate different regimens used in transrectal [TRUS] guided biopsy and to identify the optimal [TRUS] biopsy regimen, a prospective study included 80 consequent men undergoing biopsy either because of an elevated PSA> 4 ng/ml and/or abnormal digital rectal examination. Biopsies yielded 34 patients with prostate cancer giving a positive biopsy rate of 42.5%. Traditional sextant biopsy diagnosed 30 patients [88.2%]out of 34 patients with prostate cancer, while laterally directed biopsies detected 32patients [94%]. Positive transitional biopsy was positive in only two patients. No single case of prostate cancer was diagnosed only by transitional zone biopsies. The highest detection rate among traditional sextant biopsy sites were at the apex [88%] while the lowest were at the base [67.4%]. None of patients developed major complications. A sextant biopsy, far laterally oriented, regimen is the optimum transrectal biopsy regimen for detection of prostate cancer

Prenatal Diagnosis of congenital diaphragmatic hernia improves the postoperative outcome: a local experience

To date, uniform standards for congenital diaphragmatic [CDH] management have not existed. This study was to compare infants with congenital diaphragmatic hernia [CHD] who had undergone a prenatal diagnosis to those who had not undergone such diagnosis. Sixteen infants with CDH who were admitted to the neonatal intensive care unit [NICU] of Suez canal university hospital from December 2000 to August 2004 were prospectively studied. They were classified into two groups; group I including 7 infants who were prenatally diagnosed as CDH by serial ultrasound scans. In group II: 9 infants were diagnosed as having CDH after birth with no prenatal diagnosis. Special care for respiration and resuscitation was performed for all patients in the two group according to a special resuscitation protocol. After stabilization and resuscitation, surgical intervention was done under special anesthetic care. The outcome of the morbidity and mortality in both groups were studied and statistically evaluated. The mean gestational age was 37. +/- 1.05 weeds in group I in contrast to 35.18 +/- 2.7 weeks in group II. [P=0.04] and the mean birth weight was 2.5 +/- 0.8 kg in group I in contrast to 2.1 +/- 1.3 in group II. All infants required mechanical ventilation. In group I, the mean gestational age at prenatal diagnosis was 26.5 weeks. The lung area head circumference ratio [LHR] ranged from 0.36 to 0.23. associated abnormalities in group I included ventricular septal defect, atrial septal defect, polyhydramnios, premature rupture of membrane and preterm labor. In group I, the overall survival rate was 4 patients out of 7 [57.1%] in group II, 2 infants out of 9 survived with a survival rate of 22.2% with a statistically significant difference. Prenatally diagnosed infants with CDH have a better survival rate and a less morbidity compared with those who have not undergone this diagnosis

Evaluation of cervical carcinoma by MRI: detection, staging and follow up

This study is performed to evaluate the role of MR Imaging in cervical carcinoma, regarding detection of the lesions; staging and its value in follow up of previously treated cases. Thirty female patients [classified into 2 groups] presented by either positive cervical smear for cervical carcinoma or cervical mass associated with vaginal discharge were confronted in this study. Their ages ranged from 23 to 71 years old with a mean age of 47 years. All patients were subjected to MR imaging and histopathological evaluation for correlation of MRI results. MRI detected all cases within or above stage IB, either the primary tumor or tumor recurrence [27 detected cases out of 30 patients]. MRI was accurate in detection of tumor invasion of the upper or lower thirds of the vagina, extension to the pelvic wall and invasion of the bladder and rectum. MRI was able to clearly identify lymph node enlargement. The sensitivity of MRI in the 1[st] group was 87.5% and in the 2[nd] group was 100% with over all sensitivity of 90%. The overall accuracy of MRI in this study was 90%. MR Imaging is considered the primary imaging modality in detection, staging and follow up patients with cervical carcinoma. MRI is considered very helpful in detection of tumor recurrence and differentiates recurrence from post radiation changes

Axial bone mineral density and peripheral neuropathy in type 1 diabetic patients

To investigate whether peripheral neuropathy [PN], as part of the microangiopathic complex, can affect bone mineral density [BMD] of the axial skeleton in patients with type 1 diabetes. Material and Three studied groups where examined. Group 1 comprised 15 males with type 1 diabetes and severe PN, with a mean duration of diabetes of 11.07 +/- 2.31 years and an HbA1c of 9.40 +/- 1.01%. Group 2 comprised 15 male type 1 diabetic patients with absent or mild PN, matched to patients of group 1 regarding age, weight, and duration of diabetes. Group 3 comprised 15 control subjects. BMD was measured by dual energy X-ray absorptiometry [DEXA] of the axial skeleton. In group 1, BMD was significantly reduced in the axial skeleton compared with an expected Z score of 0 [spine -1.26 +/- 0.52]. To a lesser extent, but still significantly reduced, group 2 also showed reduced BMD values [spine -0.54 +/- 0.16], whereas group 3 had normal BMD values [spine, -0.19 +/- 0.23]. Group 1 had lower mean BMD level than group 2 and group 3 at the measured sites, which was statistically significant [P< 0.001]. No significant differences in physical activity levels or serum calcium, serum phosphorus, alkaline phosphatase, were demonstrated between the two patient groups. Conclusions: The present results suggest that in patients with type 1 diabetes PN may be an independent risk factor for reduced BMD in the axial skeleton

Early results of taivt trial

During the last decade few studies have been accomplished in the use of catheter directed thrombolysis for iliofemoral deep venous thrombosis to remove the thrombus completely and rapidly. These studies have shown that early thrombolysis preserve valve function and reduce the incidence of post phlebitic syndrome. However, no large randomised study has addressed its benefits, compared with those of anticoagulation. The aim of our study is to do a prospective randomised study comparing local Thrombolysis and Anticoagulant in Iliofemoral Venous Thrombosis [TAIVT trial] as regard venous function. Consecutive series of patients admitted to Suez Canal University hospital with ileofemoral DVT and comply with the inclusion criteria. Patients were randomised for either catheter directed thrombolysis using streptokinase as thrombolytic agent followed by anticoagulant or anticoagulant alone. Follow up of both arms of the trial will be at 6 weeks then 3 and 6 months post-treatment. At each follow up appointment, assessment of the venous function using colour duplex, air plethysmography and photoplethysmography.We had complete data from only 35 patients, 17 had anticoagulant and 18 had thrombolysis. At 6 months, patency rate was better in cases treated with thrombolysis, complete patency [13patients [72%] versus 2[12%], p < 0.001] and non patency [0 versus 7 [41%], p < 0.001]. Venous reflux was higher in-patients treated with anticoagulant [7 patients [41%] versus 2 [11%], p < 0.042]. Early results of the trial showed that patients treated with catheter directed thrombolysis have better venous function those with anticoagulant. This paper was presented at the XV European Surgical Vascular Society ESVS Conference. Lucerne Switzerland- September 2001

Outcome of thoracolumbar burst fractures: decompression, pedicle screw fixation and posterolateral fusion

A total of 29 patients with unstable [according to Denis classification] thoracolumbar burst injury underwent transpedicular spinal instrumentation using the SAS screw-rod system. We were able to follow-up 23 patients for more than 6 months. The 23 patients [13 males and 10 females] with mean age 33.30 +/- 10.18 years [range 19-56 years] presented with severe back pain. Four patients with complete neural injury 14 patients with partial neural injury, and 5 without neurological deficit Surgery consisted of either indirect or direct neural decompression, internal fixation, and autogenous iliac bone grafting. Annulotaxis was performed in patients with complete injury [n=4] and those with canal compromise more than <40% [n=10]. Transpedicular decompression was performed for other patients. A total of 92 pedicle screws were placed in 20 patients with one unstable motion segment and 3 patients with two unstable motion segments. All patients were submitted for routine clinical and radiographic follow-up including CT-scan. Mechanical stability was maintained through the follow-up in all patients with fusion rate of 87%. All screw purchases were satisfactory but 5 [94.57%]. Mean kyphus deformity reduced from 20.09 +/- 9.77 to 11.26 +/- . 6.25 degrees postoperative. Mean canal compromise corrected from 36.30 +/- 23.44% to 11.74 +/- 5.56% postoperative. No operative mortality, wound infection, or necessity for reoperation were reported. All patients with partial neural injury improved at least one Frankel grade. Those with complete neural injury as well as those without neurological deficit remain unchanged. Morbidity included two isolated nerve root deficits one transient and one permanent. Pedicle screw-rod fixation allows early mobilisation, short segment fixation. and preservation of adjacent motion segments. It offers high biomechanical stability with high fusion rate. The technique is dem and ing and meticulous nevertheless it is associated with minimum morbidity in trained h and s