Rationale and Objectives:The purpose of this study was to compare the accuracy of MDCT and lapa-roscopy in the prediction of peritoneal carcinomatosis index score. Reproducibility of MDCT interpreta-tion was also assessed.Methods:This prospective study included 85 ovarian cancer patients underwent MDCT and diagnosticlaparoscopy before cytoreductive surgery. We calculated the accuracy of diagnostic modalities in thecalculation of the peritoneal cancer index score (PCI). Radiologist interobserver agreement was calcu-lated using kappa statistics.Results:Nine hundred-thirty (84.2%) of the 1105 regions had peritoneal deposits at exploratory laparot-omy. Computed tomography (CT) and laparoscopy sensitivity were 94.9%, 98.3%, specificity 86.7%,80.4%, PPV 97.9 %, 96.8%, NPV 72.2%, 88.8 %, and accuracy 93.8 %, 95.7%, respectively. However,computed tomography (CT) diagnostic performance is less accurate than laparoscopy in pelvic andsmall intestinal regions; no statistically significant differences were evident regarding total PCI scorecompared to surgery (p>0.05). CT and laparoscopy correctly depicted peritoneal carcinomatosis in88.2%, 90.6% of patients, respectively. Optimal cytoreduction was achieved in 68 (80%) patients.Conclusion:Both CT and laparoscopy seems to be effective tools for assessment of peritoneal carci-nomatosis using the PCI score. Dedicated MDCT protocol with routine use of a standardized PCI formmay provide better comprehensive multi-regional analysis that may help surgeons referring patients tothe best treatment option. Laparoscopy is a valuable tool in cases with a high risk of suboptimal cytore-duction related to disease extent.

Background: The atlantoaxial joint (AAJ) plays a pivotal role in the cervical spine motion. Unfortunately, it is the most common cervical spine joint that is affected in patients with rheumatoid arthritis. Inflammation of the AAJ results in neck disability, nerve root compression, and finally spinal cord compression.Objectives: We aim to evaluate the efficacy of intraarticular triamcinolone injection of the AAJ on neck pain and disability. Study Design: A prospective randomized, controlled clinical trial.Setting: An interventional pain unit in a tertiary center at a university hospital in Egypt.Methods: Sixty patients with rheumatoid arthritis complaining of AAJ arthritis were randomized into 2 groups. Group AAJI (n = 30) received AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of 20 mg of triamcinolone, in addition to oral placebo tablets (2 tablets every 8 hours for one week). Group SS (n = 30) received systemic steroids, oral prednisolone tablets (5 mg, 2 tablets every 8 hours for one week), in addition to AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of normal saline solution. The percentage of patients who showed ≥ 50% reduction of their visual analog scale (VAS) pain score (measured at 1, 2, and 3 months postoperatively), VAS pain score and neck disability index (NDI) (measured at 2, 4, 6, 8, and 12 weeks postoperatively), and the magnetic resonance imaging (MRI) changes of AAJ (assessed 4 weeks postoperatively) were all evaluated. Results: There was significant reduction in the percentage of patients who showed ≥ 50% reduction of their VAS pain score postoperatively in group AAJI compared with group SS at one month (75% vs. 46.45%; P = 0.033), 2 months (60.7% vs. 25%; P = 0.009), and 3 months (53.6% vs. 17.9%; P = 0.007). There was significant reduction in overall VAS and overall NDI in group AAJI compared with group SS (mean ± standard error) (41.5 ± 2.6 vs. 52.1 ± 2.6; P = 0.005) and (43.7 ± 3.1 vs. 52.4 ± 3.1; P = 0.040), respectively. Analysis of postoperative MRI findings revealed significant improvement of bone marrow edema in group AAJI (AAJI vs. SS) (71.4% vs. 42.9%; P = 0.033), also the synovial enhancement disappeared significantly in group AAJI compared with group SS, (16/22 [72.7%] vs. 10/23 [43.5%]; P = 0.026), moreover, there was a significant reduction in pannus size in group AAJI compared with group SS, (6/10 [60%] vs. 1/9 [11%]; P = 0.041).Limitations: The study follow-up period was limited to only 3 months.Conclusions: For acutely inflamed AAJ due to rheumatoid arthritis, AAJ steroid injection is a potential therapeutic option; it decreased cervical neck pain, improved neck mobility, and hastened recovery of the joint from an acute inflammatory stage

Background: The atlantoaxial joint (AAJ) plays a pivotal role in the cervical spine motion. Unfortunately, it is the most common cervical spine joint that is affected in patients with rheumatoid arthritis. Inflammation of the AAJ results in neck disability, nerve root compression, and finally spinal cord compression.Objectives: We aim to evaluate the efficacy of intraarticular triamcinolone injection of the AAJ on neck pain and disability. Study Design: A prospective randomized, controlled clinical trial.Setting: An interventional pain unit in a tertiary center at a university hospital in Egypt.Methods: Sixty patients with rheumatoid arthritis complaining of AAJ arthritis were randomized into 2 groups. Group AAJI (n = 30) received AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of 20 mg of triamcinolone, in addition to oral placebo tablets (2 tablets every 8 hours for one week). Group SS (n = 30) received systemic steroids, oral prednisolone tablets (5 mg, 2 tablets every 8 hours for one week), in addition to AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of normal saline solution. The percentage of patients who showed ≥ 50% reduction of their visual analog scale (VAS) pain score (measured at 1, 2, and 3 months postoperatively), VAS pain score and neck disability index (NDI) (measured at 2, 4, 6, 8, and 12 weeks postoperatively), and the magnetic resonance imaging (MRI) changes of AAJ (assessed 4 weeks postoperatively) were all evaluated. Results: There was significant reduction in the percentage of patients who showed ≥ 50% reduction of their VAS pain score postoperatively in group AAJI compared with group SS at one month (75% vs. 46.45%; P = 0.033), 2 months (60.7% vs. 25%; P = 0.009), and 3 months (53.6% vs. 17.9%; P = 0.007). There was significant reduction in overall VAS and overall NDI in group AAJI compared with group SS (mean ± standard error) (41.5 ± 2.6 vs. 52.1 ± 2.6; P = 0.005) and (43.7 ± 3.1 vs. 52.4 ± 3.1; P = 0.040), respectively. Analysis of postoperative MRI findings revealed significant improvement of bone marrow edema in group AAJI (AAJI vs. SS) (71.4% vs. 42.9%; P = 0.033), also the synovial enhancement disappeared significantly in group AAJI compared with group SS, (16/22 [72.7%] vs. 10/23 [43.5%]; P = 0.026), moreover, there was a significant reduction in pannus size in group AAJI compared with group SS, (6/10 [60%] vs. 1/9 [11%]; P = 0.041).Limitations: The study follow-up period was limited to only 3 months.Conclusions: For acutely inflamed AAJ due to rheumatoid arthritis, AAJ steroid injection is a potential therapeutic option; it decreased cervical neck pain, improved neck mobility, and hastened recovery of the joint from an acute inflammatory stage

Background: The atlantoaxial joint (AAJ) plays a pivotal role in the cervical spine motion. Unfortunately, it is the most common cervical spine joint that is affected in patients with rheumatoid arthritis. Inflammation of the AAJ results in neck disability, nerve root compression, and finally spinal cord compression.Objectives: We aim to evaluate the efficacy of intraarticular triamcinolone injection of the AAJ on neck pain and disability. Study Design: A prospective randomized, controlled clinical trial.Setting: An interventional pain unit in a tertiary center at a university hospital in Egypt.Methods: Sixty patients with rheumatoid arthritis complaining of AAJ arthritis were randomized into 2 groups. Group AAJI (n = 30) received AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of 20 mg of triamcinolone, in addition to oral placebo tablets (2 tablets every 8 hours for one week). Group SS (n = 30) received systemic steroids, oral prednisolone tablets (5 mg, 2 tablets every 8 hours for one week), in addition to AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of normal saline solution. The percentage of patients who showed ≥ 50% reduction of their visual analog scale (VAS) pain score (measured at 1, 2, and 3 months postoperatively), VAS pain score and neck disability index (NDI) (measured at 2, 4, 6, 8, and 12 weeks postoperatively), and the magnetic resonance imaging (MRI) changes of AAJ (assessed 4 weeks postoperatively) were all evaluated. Results: There was significant reduction in the percentage of patients who showed ≥ 50% reduction of their VAS pain score postoperatively in group AAJI compared with group SS at one month (75% vs. 46.45%; P = 0.033), 2 months (60.7% vs. 25%; P = 0.009), and 3 months (53.6% vs. 17.9%; P = 0.007). There was significant reduction in overall VAS and overall NDI in group AAJI compared with group SS (mean ± standard error) (41.5 ± 2.6 vs. 52.1 ± 2.6; P = 0.005) and (43.7 ± 3.1 vs. 52.4 ± 3.1; P = 0.040), respectively. Analysis of postoperative MRI findings revealed significant improvement of bone marrow edema in group AAJI (AAJI vs. SS) (71.4% vs. 42.9%; P = 0.033), also the synovial enhancement disappeared significantly in group AAJI compared with group SS, (16/22 [72.7%] vs. 10/23 [43.5%]; P = 0.026), moreover, there was a significant reduction in pannus size in group AAJI compared with group SS, (6/10 [60%] vs. 1/9 [11%]; P = 0.041).Limitations: The study follow-up period was limited to only 3 months.Conclusions: For acutely inflamed AAJ due to rheumatoid arthritis, AAJ steroid injection is a potential therapeutic option; it decreased cervical neck pain, improved neck mobility, and hastened recovery of the joint from an acute inflammatory stage

Background: The atlantoaxial joint (AAJ) plays a pivotal role in the cervical spine motion. Unfortunately, it is the most common cervical spine joint that is affected in patients with rheumatoid arthritis. Inflammation of the AAJ results in neck disability, nerve root compression, and finally spinal cord compression.Objectives: We aim to evaluate the efficacy of intraarticular triamcinolone injection of the AAJ on neck pain and disability. Study Design: A prospective randomized, controlled clinical trial.Setting: An interventional pain unit in a tertiary center at a university hospital in Egypt.Methods: Sixty patients with rheumatoid arthritis complaining of AAJ arthritis were randomized into 2 groups. Group AAJI (n = 30) received AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of 20 mg of triamcinolone, in addition to oral placebo tablets (2 tablets every 8 hours for one week). Group SS (n = 30) received systemic steroids, oral prednisolone tablets (5 mg, 2 tablets every 8 hours for one week), in addition to AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of normal saline solution. The percentage of patients who showed ≥ 50% reduction of their visual analog scale (VAS) pain score (measured at 1, 2, and 3 months postoperatively), VAS pain score and neck disability index (NDI) (measured at 2, 4, 6, 8, and 12 weeks postoperatively), and the magnetic resonance imaging (MRI) changes of AAJ (assessed 4 weeks postoperatively) were all evaluated. Results: There was significant reduction in the percentage of patients who showed ≥ 50% reduction of their VAS pain score postoperatively in group AAJI compared with group SS at one month (75% vs. 46.45%; P = 0.033), 2 months (60.7% vs. 25%; P = 0.009), and 3 months (53.6% vs. 17.9%; P = 0.007). There was significant reduction in overall VAS and overall NDI in group AAJI compared with group SS (mean ± standard error) (41.5 ± 2.6 vs. 52.1 ± 2.6; P = 0.005) and (43.7 ± 3.1 vs. 52.4 ± 3.1; P = 0.040), respectively. Analysis of postoperative MRI findings revealed significant improvement of bone marrow edema in group AAJI (AAJI vs. SS) (71.4% vs. 42.9%; P = 0.033), also the synovial enhancement disappeared significantly in group AAJI compared with group SS, (16/22 [72.7%] vs. 10/23 [43.5%]; P = 0.026), moreover, there was a significant reduction in pannus size in group AAJI compared with group SS, (6/10 [60%] vs. 1/9 [11%]; P = 0.041).Limitations: The study follow-up period was limited to only 3 months.Conclusions: For acutely inflamed AAJ due to rheumatoid arthritis, AAJ steroid injection is a potential therapeutic option; it decreased cervical neck pain, improved neck mobility, and hastened recovery of the joint from an acute inflammatory stage

Background: The atlantoaxial joint (AAJ) plays a pivotal role in the cervical spine motion. Unfortunately, it is the most common cervical spine joint that is affected in patients with rheumatoid arthritis. Inflammation of the AAJ results in neck disability, nerve root compression, and finally spinal cord compression.Objectives: We aim to evaluate the efficacy of intraarticular triamcinolone injection of the AAJ on neck pain and disability. Study Design: A prospective randomized, controlled clinical trial.Setting: An interventional pain unit in a tertiary center at a university hospital in Egypt.Methods: Sixty patients with rheumatoid arthritis complaining of AAJ arthritis were randomized into 2 groups. Group AAJI (n = 30) received AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of 20 mg of triamcinolone, in addition to oral placebo tablets (2 tablets every 8 hours for one week). Group SS (n = 30) received systemic steroids, oral prednisolone tablets (5 mg, 2 tablets every 8 hours for one week), in addition to AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of normal saline solution. The percentage of patients who showed ≥ 50% reduction of their visual analog scale (VAS) pain score (measured at 1, 2, and 3 months postoperatively), VAS pain score and neck disability index (NDI) (measured at 2, 4, 6, 8, and 12 weeks postoperatively), and the magnetic resonance imaging (MRI) changes of AAJ (assessed 4 weeks postoperatively) were all evaluated. Results: There was significant reduction in the percentage of patients who showed ≥ 50% reduction of their VAS pain score postoperatively in group AAJI compared with group SS at one month (75% vs. 46.45%; P = 0.033), 2 months (60.7% vs. 25%; P = 0.009), and 3 months (53.6% vs. 17.9%; P = 0.007). There was significant reduction in overall VAS and overall NDI in group AAJI compared with group SS (mean ± standard error) (41.5 ± 2.6 vs. 52.1 ± 2.6; P = 0.005) and (43.7 ± 3.1 vs. 52.4 ± 3.1; P = 0.040), respectively. Analysis of postoperative MRI findings revealed significant improvement of bone marrow edema in group AAJI (AAJI vs. SS) (71.4% vs. 42.9%; P = 0.033), also the synovial enhancement disappeared significantly in group AAJI compared with group SS, (16/22 [72.7%] vs. 10/23 [43.5%]; P = 0.026), moreover, there was a significant reduction in pannus size in group AAJI compared with group SS, (6/10 [60%] vs. 1/9 [11%]; P = 0.041).Limitations: The study follow-up period was limited to only 3 months.Conclusions: For acutely inflamed AAJ due to rheumatoid arthritis, AAJ steroid injection is a potential therapeutic option; it decreased cervical neck pain, improved neck mobility, and hastened recovery of the joint from an acute inflammatory stage

Purpose:To evaluate the role of non-contrast multidetector CT (MDCT) reliability in localizing CSF leaksand skull base defects in correlation to operative findings.Materials and methods:Twenty patients clinically diagnosed to have CSF rhinorrhea; 8 spontaneous and12 post-traumatic patients were evaluated using 64-rows MDCT with slice section 0.6 mm. CT is consid-ered accurate if correctly determine the site and size of bony defect as matched with operative findings.Results:MDCT accurately detected the site of presumed CSF leak in 19 out of 20 cases with sensitivity95%. Cribriform plate defect is the most common site of defect in 40% of cases with 75% of cases catego-rized as Keros type II. The consensus image with fair agreement (K = 0.38) shows that coronal reformathas the highest diagnostic performance in 75% of cases while the least diagnostic value is encounteredwith the axial plane in 15% of cases (p = 0.095). There is almost a perfect agreement (K = 0.810) betweenthe MDCT measurements and operative size of bony defect with minimal difference in 10% of patients(P 0.001).Conclusion:Non-contrast MDCT is an accurate reliable non-invasive imaging modality for preoperativeevaluation of CSF rhinorrhea

Purpose:To evaluate the role of non-contrast multidetector CT (MDCT) reliability in localizing CSF leaksand skull base defects in correlation to operative findings.Materials and methods:Twenty patients clinically diagnosed to have CSF rhinorrhea; 8 spontaneous and12 post-traumatic patients were evaluated using 64-rows MDCT with slice section 0.6 mm. CT is consid-ered accurate if correctly determine the site and size of bony defect as matched with operative findings.Results:MDCT accurately detected the site of presumed CSF leak in 19 out of 20 cases with sensitivity95%. Cribriform plate defect is the most common site of defect in 40% of cases with 75% of cases catego-rized as Keros type II. The consensus image with fair agreement (K = 0.38) shows that coronal reformathas the highest diagnostic performance in 75% of cases while the least diagnostic value is encounteredwith the axial plane in 15% of cases (p = 0.095). There is almost a perfect agreement (K = 0.810) betweenthe MDCT measurements and operative size of bony defect with minimal difference in 10% of patients(P 0.001).Conclusion:Non-contrast MDCT is an accurate reliable non-invasive imaging modality for preoperativeevaluation of CSF rhinorrhea

Purpose:To evaluate the role of non-contrast multidetector CT (MDCT) reliability in localizing CSF leaksand skull base defects in correlation to operative findings.Materials and methods:Twenty patients clinically diagnosed to have CSF rhinorrhea; 8 spontaneous and12 post-traumatic patients were evaluated using 64-rows MDCT with slice section 0.6 mm. CT is consid-ered accurate if correctly determine the site and size of bony defect as matched with operative findings.Results:MDCT accurately detected the site of presumed CSF leak in 19 out of 20 cases with sensitivity95%. Cribriform plate defect is the most common site of defect in 40% of cases with 75% of cases catego-rized as Keros type II. The consensus image with fair agreement (K = 0.38) shows that coronal reformathas the highest diagnostic performance in 75% of cases while the least diagnostic value is encounteredwith the axial plane in 15% of cases (p = 0.095). There is almost a perfect agreement (K = 0.810) betweenthe MDCT measurements and operative size of bony defect with minimal difference in 10% of patients(P 0.001).Conclusion:Non-contrast MDCT is an accurate reliable non-invasive imaging modality for preoperativeevaluation of CSF rhinorrhea

Objectives:The objectives of this study were the evaluation of low dose multidetector com-puted tomography (MDCT) in localizing the site of the transition zone (TZ) ofHirschsprung’s Disease (HD) for preoperative planning.Patients and methods:Twenty-two infants were recruited from pediatric and surgical clin-ics in Assiut University Hospital and Sohag University Hospital. The recruited patients weresedated before examination. Examinations were done using 64-rows MDCT. Each MDCTexamination was reviewed to determine the location and length of the TZ and comparedwith operative and pathological results. Results were analyzed by chi square test and inter-observer agreement using Kappa test.P 0.05 was considered statistically significant.Results:According to operative and pathological data, the site of the TZ: 17 (77.27%) wereof short-segment disease (rectosigmoid HD), 2 (9%) were of long segment (above sigmoidcolon), and 3 (13.63%) were of ultrashort segment. A correct diagnosis of TZ by MDCT wasmade in 19 out of 22 with 82.4% sensitivity and 80% specificity. The site of TZ wasconcordant in 17. Results yielded a moderate strength of inter-observer agreement in local-izing the site of TZ (k= 0.546) and (P= 0.009).Conclusion:Low-dose MDCT has a good role in localizing the site of TZ of HD in infants.