AB0876 Can ultrasonographic peripheral enthesitis mirror spinal radiographic abnormalities and other disease parameters in patients radiographic axial SpA?

Background

Although enthesitis is the hallmark of spondyloarthritides, the association between peripheral enthesitis, radiographic spinal affection and disease assessment parameters is still underestimated.

Objectives

In this cross-sectional prospective study, we aimed to evaluate the relation of US pattern of peripheral enthesitis with the spinal radiographic changes and other disease parameters in patients with radiographic axial spondyloarthritis (SpA).

Methods

Fifty-eight patients with radiographic axial SpA (ASAS criteria) were studied for the presence and pattern of peripheral lower limb enthesitis according to the Outcome Measures in Rheumatology (OMERACT) US definitions: Achilles tendon, plantar fascia, proximal and distal patellar ligaments, and quadriceps tendon insertions. The findings then were correlated with the radiographic spinal abnormalities, Bath AS radiographic index (BASRI), Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), and Bath AS metrology index (BASMI) together with the HLA-B27 status and inflammatory markers using Spearmann rho correlation co-efficient.

Results

The mean age was 37.96 (±13.1) years, 75.86% were males. Thirty-six patients (62%) had US enthesitis (USE) with a mean age of 39.2 (±12.8). HLA-B27 was positive in 61% of patients with USE and 54.5% in those without. There was no difference between patients with and without USE regarding the disease duration, age at onset but those with USE showed less diagnostic delay (p = 0.03). Clinical enthesitis and peripheral arthritis were more frequent in those with USE (50% vs 22.7% and 25% vs 13.6% respectively). No statistical significant difference has been found between the inflammatory, structural and total scores of USE and BASRI, BASFI and BASDAI (p > 0.05). No correlation could be detected between BASRI and USE scores (rs= 0.12, p =0.45 for inflammatory, rs=0.25, p=0.11 for structural and rs=0.18, p=0.28 for total score). There was a positive correlation between BASMI and both inflammatory and total scores of USE (rs= 0.485, p=0.003). No significant association between BASDAI, CRP or ESR and USE scores.

Conclusion

Ultrasonographic peripheral entheseal abnormalities couldn’t reflect the spinal radiographic changes or disease assessment parameters in patients with radiographic axial SpA. However, these results can be considered preliminary and more studies on wider scales are needed to support our findings.

Disclosure of Interests

Abdelhfeez Moshrif Speakers bureau: Amgen, Jansen, Novartis, Mohamed Ismail Abdelkareem Speakers bureau: Abbvie, Jansen, Novartis and Organon, Sonya Rashad: None declared, Ahmed Negm: None declared, Ahmed Mosallam Speakers bureau: Amgen, Pfizer and Novartis, Hassan Bassiouni Speakers bureau: Abbvie, Jansen, Novartis, and MSD

Extensive brain swelling with neurological deterioration after intracranial meningioma surgery - venous complication or 'unspecific' increase in tissue permeability

OBJECTIVE

We retrospectively analyzed a series of patients who deteriorated after resection of an intracranial meningioma due to extensive brain edema (EBE) with regard to etiology of the neurological worsening and outcome.

METHODS

Out of a series of 376 consecutive patients who underwent resection of an intracranial meningioma, 13 (3.5%) experienced postoperative deterioration due to EBE which necessitated prolonged artificial ventilation, tracheal reintubation, or decompressive craniectomy. Clinical data, radiological findings, operative records and follow-up data of these patients were retrospectively reviewed.

RESULTS

The study revealed two different patient groups: Patients in group A (n=7) demonstrated edema due to typical venous infarction (VI). A decompressive craniotomy was performed in all but one patient in this group; nonetheless, an acceptable neurological outcome (Glasgow Outcome Scale (GOS) 4) was achieved in only two cases. Patients in group B (n=6) deteriorated due to an EBE of unknown etiology. Mean tumor volume in this group was higher when compared to group A (75 ml vs. 30 ml). In addition, 83% of patients in group B displayed extensive preoperative peritumoral edema compared to only 14% in group A. Three patients in group B required decompressive surgery; however, neurological outcome was more favorable in this group as 83% achieved a GOS of 4 or 5.

CONCLUSION

Extensive brain swelling during or after intracranial meningioma surgery may be due to VI or possibly due to increased postoperative tissue permeability. It is recommended to preserve all venous structures as patients with VI had an unfavorable neurological outcome.

Intracranial Hemangiopericytoma: Treatment Outcomes in a Consecutive Series

OBJECTIVE

The purpose of this study was to analyse a series of patients harbouring an intracranial hemangiopericytoma (HPC) with respect to clinical presentation, treatment results and long-term follow-up outcomes.

PATIENTS AND METHODS

Clinical data were retrospectively obtained in a series of 12 patients who underwent microsurgical resection for HPC at two neurosurgical institutions between 1987 and 2004.

RESULTS

The main presenting symptoms in the seven men and five women (mean age 38 years) were headache in 50% and epileptic seizures in 33% of the patients. A Simpson grade I resection was achieved in seven patients (58%) and none of these patients developed local tumour recurrence after a mean follow-up period of 127 months (10.6 yrs). Only one of these patients received adjuvant radiotherapy. A recurrence of the HPC was observed in all patients (42%) who underwent subtotal tumour resection at first surgery (Simpson grade II or higher). Recurrences occurred after a mean period of 39 months (3.2 yrs) after primary surgery and were effectively controlled by surgical excision, radiotherapy and gamma knife radiosurgery. Two patients (17%) developed extraneural metastases which were treated by surgical excision, radiotherapy and salvage chemotherapy. Poly-chemotherapy was ineffective with respect to tumour control in this study.

CONCLUSIONS

The study emphasises the importance of total resection of HPC, defined as a Simpson grade I removal, at first surgery. Adjuvant radiotherapy is recommended after subtotal tumour resections. A life-long vigilant follow-up of these patients is mandatory.

Olfactory groove meningiomas: functional outcome in a series treated microsurgically

BACKGROUND

A systematic investigation of long-term follow-up results after microsurgical treatment of patients harbouring an olfactory groove meningioma, particularly with regard to postoperative olfactory and mental function, has rarely been performed. We reassessed a series of patients treated microsurgically for an olfactory groove meningioma in regard to clinical presentation, surgical approaches and long-term functional outcome.

METHOD

Clinical, radiological and surgical data in a consecutive series of 56 patients suffering from olfactory groove meningioma were retrospectively reviewed.

FINDINGS

Presenting symptoms of the 41 women and 15 men (mean age 51 years) were mental changes in 39.3%, visual impairment in 16.1% and anosmia in 14.3% of the patients. Preoperative neurological examination revealed deficits in olfaction in 71.7%, mental disturbances in 55.4% and reduced vision in 21.4% of the cases. The tumour was resected via a bifrontal craniotomy in 36, a pterional route in 13, a unilateral frontal approach in 4 and via a supraorbital approach in 3 patients. Extent of tumour resection according to Simpson's classification system was grade I in 42.9% and grade II in 57.1% of the cases. After a mean follow-up period of 5.6 years (range 1-13 years) by clinical examination and magnetic resonance imaging (MRI), 86.8% of the patients resumed normal life activity. Olfaction was preserved in 24.4% of patients in whom pre- and postoperative data were available. Mental and visual disturbances improved in 88 and 83.3% of cases, respectively. Five recurrences (8.9%) were observed and had to be reoperated.

CONCLUSIONS

Frontal approaches allowed better resection of tumours with gross infiltration of the anterior cranial base, tumours extending into the ethmoids or nasal cavity and in cases with deep olfactory grooves. Preservation of olfaction should be attempted in patients with normal or reduced smelling preoperatively.

Sensitivity versus specificity of phonoarthrography as an indicator for cartilage degeneration

In an attempt to update the idea of recording knee sounds, 400 osteoarthritic (OA) knees, 100 knees from a young age group (18-31 years) and 100 knees from an age-matching group (45-60 years) were recorded by a computerized device using a special program that enabled the conversion of sounds--recorded in a fixed lapse of time--to waves which were then analysed in terms of frequency/second and average amplitude. Radiological grading was done for all groups in order to compare both parameters. Reproducibility of the recordings for each knee was confirmed statistically. Phonoarthrography was found to be 100% sensitive for radiological changes and for clinically felt crepitus, simultaneously diagnosing early OA in 32.5% of subjects with no radiological changes and in 7.5% of subjects with no clinically felt crepitus. From the work it can be deduced that computerized phonoarthrography can diagnose early cases of OA and is excellent for assessing and following up cases. It may be regarded as an indicator for cartilage degeneration.

Aging of the thoracic spine: distinction between wedging in osteoarthritis and fracture in osteoporosis--a cross-sectional and longitudinal study

Thoracic kyphosis is clinically associated with osteoporosis as well as with osteoarthritis. Because misinterpretation of thoracic spine deformities on X-rays may lead to overdiagnosis of vertebral fracture, we studied morphological changes of the thoracic spine in a cross-sectional (n = 89) and longitudinal study (n = 38) in 30 women with established osteoporosis (OP), in 31 women with spinal osteoarthritis (OA), and in 28 normal women. Vertebral deformation was assessed on lateral roentgenograms of the thoracic spine from T-4-T-12. The anterior, middle, and posterior heights were measured using six points corresponding to the four corners of the vertebral body excluding osteophytes and the midpoints of the endplates. For the thoracic T-6-T-9 region, the mean anterior/posterior height ratio was 7.7% in the controls, 13% in osteoarthritis, and 21% in osteoporosis. For the mid-height/posterior height ratio the respective values were 13%, 12%, and 22%. The osteoporosis group differed significantly from the control and osteoarthritis group in anterior and in midheight reduction. The yearly mean anterior height reduction in the osteoarthritis group was 0.7% compared with 1.5% in the osteoporosis group. The mean yearly midheight reduction was, respectively, 0.5% versus 2.9%. The differences between the groups were significant. We conclude that vertebral deformity, in particular wedging, of the thoracic spine is not exclusively characteristic for osteoporosis and that certain vertebral deformities develop by mechanisms other than fracture. Osteoporotic fracture of the thoracic spine is characterized by an exaggerated reduction of the midheight to posterior height in addition to reduction of the anterior to posterior height.(ABSTRACT TRUNCATED AT 250 WORDS)