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.

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.

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.

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.

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.

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.

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