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.

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.

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.

Abstract Background: The indications for and technology surrounding thoracic endovascular aortic repair (TEVAR) have undergone significant evolution with increasing adoption. The purpose of this report is to evaluate pathology-specific incidence, timing, and types of secondary aortic intervention (SAI) after TEVAR and their impact on survival. Methods: A single-center retrospective review was made of all TEVAR and SAI performed from 2004 to 2018. Kaplan-Meier and multivariable logistic regression were used to estimate freedom from SAI and survival, and to identify SAI predictors. Results: Of 1037 patients (mean age 65.4 ± 15.1 years), 155 (14.9%) underwent 212 SAIs (median 5 months; interquartile range, 1.5 to 18) with 37 (3.6%) requiring more than one SAI. The primary aortic pathology at index TEVAR significantly (P = .0001) affected the incidence of SAI: chronic dissection, 26.5%; postsurgical anastomotic pseudoaneurysm, 19.4%; degenerative aneurysm, 15.3%; and acute dissection, 11.2%. The most common indications for SAI were endoleaks (44.8%), disease progression or remote aortic procedure (23.1%), and persistent false lumen flow (9.9%). After exclusion of 30-day mortality events, patients who did not undergo a SAI had better survival compared with patients having SAI: no SAI 1 year 88.8% ± 1.1%, 5 years 75.2% ± 1.7%, and 10 years, 66.5% ± 2.3%; SAI 1 year 91.7% ± 2.4%, 5 years 61.9% ± 4.9%, and 10 years 33.5% ± 8.4% (log rank P = .004). Conclusions: Secondary aortic intervention after TEVAR is not uncommon, particularly among patients with chronic dissection pathology. Patients surviving their index hospitalization who undergo SAI have worse long-term survival. The varying incidence of SAI by indication identifies the need for pathology-specified patient selection, surveillance strategies after TEVAR, and better device design that addresses the limitations of TEVAR, particularly in dealing with dissection-related indications.

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