The accuracy of dynamic Magnetic Resonance Imaging in evaluation of internal derangement of the temporomandibular joint; comparison with arthroscopic findings

Purpose

To determine the correlation between dynamic Magnetic Resonance Imaging (MRI) and arthroscopy findings in internal derangement of the temporo-mandibular joint (TMJ).

Material and methods

This study was conducted on 25 patients (of 28 TMJs), 18 females and 7 males their age ranging from 20 to 42 years (mean 31 years). All patients were submitted to MRI examination of the TMJ. All of these patients underwent arthroscopy for diagnosis and treatment and results were compared with dynamic MRI findings.

Results

Concerning disc position, MR examination revealed 24 TMJs out of 28 (85.7%) with anteriorly displaced discs, while 4 TMJs (15.3%) showed normal disc position. When type of displacement was considered, MRI revealed 8 TMJs (28.7%) with anterior disc displacement with reduction (ADDWR), while 16 TMJs (57.1%) with anterior disc displacement without reduction (ADDWOR). While arthroscopy revealed 6 TMJs out of 28 (21.4%) with ADDWR, 14 TMJs (50%) showed ADDWOR and 8 TMJs (28.6%) with normal disc position.MRI assessment of disc mobility revealed 12 out of 28 TMJs (42.8%) with limited asynchronous movements, while 3 TMJs (10.7%) with stuck disc, and 13 TMJs (46.4%) with normal mobility. While arthroscopy revealed 11 out of 28 TMJs (39.2%) with limited disc mobility, 1 TMJs (3.5%) with stuck disc, and 16 TMJs (57.1%) with normal mobility.The results of this study showed no significant statistical difference between arthroscopy and MRI in diagnosing disc position and disc mobility.

Conclusions

Both arthroscopy and dynamic MRI are statistically correlated with each other in detecting TMJ internal derangement. Nevertheless, reviewing the results highlighted the advantages of MRI augmented by dynamic protocol over arthroscopy in diagnosing disc position and mobility and hence, we recommend using MRI as a first line diagnostic modality when internal derangement is suspected.     

Salvage intraperitoneal therapy of small-volume residual ovarian cancer: impact of pretreatment finding of peritoneal carcinomatosis on the surgical complete response rate

Summary Second-line intraperitoneal (i.p.) therapy has been demonstrated to result in surgically defined complete responses (S-CR) in 25%–40% of patients with small-volume residual ovarian cancer (microscopic disease or largest tumor mass <1 cm in diameter). To evaluate the influence of the surgical finding of diffuse peritoneal carcinomatosis on the S-CR rate to salvage i.p. therapy in this patient population, we retrospectively reviewed the operative reports of 70 patients with small-volume residual ovarian cancer treated on one of three phase-2 second-line i.p. trials at the Memorial Sloan-Kettering Cancer Center. Of the 11 patients with diffuse carcinomatosis, none achieved a S-CR compared to a S-CR rate of 37% (22/59) in patients without this surgical finding (²=6.0;P<0.025). However, of the 7 patients with diffuse carcinomatosis treated on a cisplatin-based i.p. program, the only 2 who had previously responded to systemic platinum also experienced a response (partial) to the i.p. cisplatin regimen. In conclusion, while the surgical finding of diffuse peritoneal carcinomatosis indicates a poor prognosis in patients with small-volume residual ovarian cancer for response to i.p. chemotherapy, patients in this clinical setting with prior evidence of platinum sensitivity may experience some benefit from an i.p. cisplatin-based treatment strategy.Supported in part by the Avon Program in Ovarian Cancer, Memorial Sloan-Kettering Cancer Center     

Phase 2 trial of chronic low-dose oral etoposide as salvage therapy of platinum-refractory ovarian cancer

Summary Eighteen previously treated patients with advanced ovarian cancer were entered into a phase 2 trial of chronic low-dose oral etoposide (50 mg/day for 20 days, repeated every 28 days) to determine the activity of this therapeutic strategy in organoplatinum-refractory disease. The treatment program was generally well tolerated, with mild neutropenia the most common side-effect encountered. One patient (6%; 95% confidence interval=0–17%) achieved a partial response, which lasted for 11 months. Three additional patients (17%), who failed to meet the criteria of a partial response, demonstrated objective evidence of antineoplastic activity. Chronic low-dose oral etoposide administration is associated with definite, although modest, activity in platinumrefractory ovarian cancer.Supported in part by the Avon Program in Ovarian Cancer, Memorial Sloan-Kettering Cancer Center, NCI grant 52477, and a grant from the Bristol-Myers Oncology Division     

Design and biological activities of L-163,191 (MK-0677): a potent, orally active growth hormone secretagogue.

A potent, orally active growth hormone (GH) secretagogue L-163,191 belonging to a recently synthesized structural class has been characterized. L-163,191 releases GH from rat pituitary cells in culture with EC50 = 1.3 +/- 0.09 nM and is mechanistically indistinguishable from the GH-releasing peptide GHRP-6 and the prototypical nonpeptide GH secretagogue L-692,429 but clearly distinguishable from the natural GH secretagogue, GH-releasing hormone. L-163,191 elevates GH in dogs after oral doses as low as 0.125 mg/kg and was shown to be specific in its release of GH without significant effect on plasma levels of aldosterone, luteinizing hormone, thyroxine, and prolactin after oral administration of 1 mg/kg. Only modest increases in cortisol were observed. Based on these properties, L-163,191 has been selected for clinical studies.     

Haemopericardium causing cardiac tamponade: a late complication of pectus excavatum repair

A 24 year old man presented to the emergency department with clinical signs of cardiac tamponade requiring emergency surgery. The cause was a sternal wire from a pectus excavatum repair two years previously that had fractured and migrated through the pericardium causing an epicardial injury and a haemopericardium.     

Comparison between intensity normalization techniques for dynamic susceptibility contrast (DSC)-MRI estimates of cerebral blood volume (CBV) in human gliomas

Purpose:

To compare “standardization,” “Gaussian normalization,” and “Z‐score normalization” intensity transformation techniques in dynamic susceptibility contrast magnetic resonance imaging (DSC‐MRI) estimates of cerebral blood volume (CBV) in human gliomas. DSC‐MRI is a well‐established biomarker for CBV in brain tumors; however, DSC‐MRI estimates of CBV are semiquantitative. The use of image intensity transformation algorithms provides a mechanism for obtaining quantitatively similar CBV maps with the same intensity scaling.

Materials and Methods:

The coefficient of variance (CV) in normal‐appearing white matter and relative contrast between tumor regions and normal tissue was compared between the three CBV transformations across five different MR scanners in 96 patients with gliomas.

Results:

The results suggest all normalization techniques improved variability and relative tumor contrast of CBV measurements compared with nonnormalized CBV maps. The results suggest Gaussian normalization of CBV maps provided slightly lower CV in normal white matter and provided slightly higher tumor contrast for glioblastomas (WHO grade IV) compared with other techniques.

Conclusion:

The results suggest Gaussian normalization of leakage‐corrected CBV maps may be the best choice for image intensity correction for use in large‐scale, multicenter clinical trials where MR scanners and protocols vary widely due to ease of implementation, lowest variability, and highest tumor to normal tissue contrast. J. Magn. Reson. Imaging 2012;35:1472–1477. © 2012 Wiley Periodicals, Inc.     

Multimodality imaging of splenic lesions and the role of non-vascular,image-guided intervention

Splenic lesions are often incidentally detected on abdominal-computed tomography (CT), ultrasound, or magnetic resonance imaging (MRI), and these can pose a diagnostic challenge in patients with suspected or known malignancy. This review will discuss the multimodality imaging features of various benign and malignant splenic pathologies including trauma, infection, infarct, granulomatous disease, benign neoplasms such as hemangioma, hamartoma, and littoral cell angioma, cystic entities such as peliosis, splenic cysts, and pseudocysts, and malignant processes such as metastasis, lymphoma, angiosarcoma, and leiomyosarcoma. While several of these splenic pathologies have characteristic imaging features that are helpful in diagnosis, others have nonspecific findings. In such clinical dilemmas, image-guided intervention may be essential, and we therefore discuss the role of non-vascular, image-guided splenic interventions for diagnostic and therapeutic purposes. The radiologist can play a key part in the clinical diagnosis and management of splenic lesions, and therefore a thorough knowledge of the imaging features of splenic lesions and a thoughtful approach to their management is crucial.     

Shear Strength of Externally U-Bonded Carbon Fiber-Reinforced Polymer High-Strength Reinforced Concrete

In this paper, we investigate the contribution of Fiber-Reinforced Polymer (FRP) to the load-carrying capacity of shear-strengthened Reinforced Concrete (RC) beams. Specifically, the investigation is focused on the FRP’s contribution in the presence and absence of shear stirrups. To this end, two sets of full-scale RC beam specimens were tested to failure in a simply supported setup. Set 1 consisted of specimens without shear stirrups whereas Set 2 included steel stirrups spaced at 170 mm. One and two layers of FRP discrete strips were bonded to the beams in a U-jacketing configuration. To investigate the contribution of FRP and its interaction with the stirrups, two different locations were considered when bonding the FRP strips: between the stirrups (referred to as Off-beams) and at the same level of the stirrups (referred to as On). Results of the experimental program showed that strengthening the beams with two layers of FRP does not necessarily translate to improved capacity. Furthermore, the location of FRP strips with respect to the location of shear stirrups has an influence on the beam’s overall behavior, especially its displacement ductility. This is an important parameter to consider to avoid premature failure of RC members. Test results were then used to assess the performance and accuracy of the predictions of ACI PRC-440.2-17 and fib-TG9.3. Both design codes were found to be conservative with an average prediction-to-test ratio of 0.7.