The Role of Ultrasound in Assessing Hand Joints and Tendons in Psoriatic Arthritis.

INTRODUCTION: Psoriatic arthritis (PsA) is an inflammatory arthritis, usually involving peripheral joints, associated with cutaneous psoriasis, in the absence of rheumatoid factor and anti-citrullinated protein antibodies. MATERIAL AND METHODS: The study included 28 patients diagnosed with psoriatic arthritis according to CASPAR criteria, presenting pain or swelling of the small joints of the hands and wrists, hospitalized in the Department of Rheumatology of the Emergency Clinical County Hospital of Craiova during 2016-2018. RESULTS: In the 28 patients, a total of 840 joints were examined clinically and by ultrasound. From the clinical point of view, out of the total, 32 joints were swollen while 59 joints were tender. Dactylitis was evidenced in 20/280 examined digits upon physical examination. MUS revealed the presence of synovial proliferation in 108/840 sites (12.85%), with grade 1 synovitis in 4 joints (3.7%), grade 2 in 94 joints (87.03%) and grade 3 in 10 joints (9.25%). Out of 280 examined fingers 5.71% presented dactylitis, the third digit being the most commonly targeted. Grade 2 tenosynovitis was found in 40 of the examined tendons, whereas 8 tendons presented with grade 3 tenosynovitis. The most frequently involved were the flexor tendons of the digits (38 out of 40 tendons with inflammatory changes), followed by the extensor carpi ulnaris and flexor carpi radialis tendons. CONCLUSIONS: Ultrasound has proven its utility in assessing joint and tendon inflammation to a higher extent that clinically expected. Thus, MUS examination of hand joints may aid the clinician in diagnosing PsA, in evaluating the prognosis and the course of treatment.

Clinical and Ultrasound Assessment of Enthesis in Psoriatic Arthritis in a Romanian Cohort.

INTRODUCTION: Spondyloarthritis (SpA) is a group of chronic inflammatory disorders which includes ankylosing spondylitis (SA), psoriatic arthritis (PsA), reactive arthritis (ReA), arthritis associated with inflammatory bowel disease (IBD) and undifferentiated spondyloarthritis (uSpA). The enthesis, the area of insertion of the tendon, ligament or joint capsule onto the bone, can be characterized as a central feature in PsA. MATERIAL AND METHODS: The study included a number of 28 patients, 18 females and 10 males, with PsA hospitalized during 2016-2018 in the Department of Rheumatology of the Emergency County Hospital of Craiova. All the patients were diagnosed with psoriatic arthritis according to CASPAR criteria and had a history of entheseal pain, mandatory criteria for inclusion in the study. All patients underwent clinical examination, laboratory tests and musculoskeletal ultrasonography (MSUS). RESULTS: The Belgrade Ultrasound Enthesitis Score (BUSES) was not significantly associated either with ESR (p=0.536) or CRP (p=0.965) values. Furthermore, the clinical evaluation through the LEEDS enthesitis index (LEI) showed no significant association with ESR (p=0.067) or CRP (p=0.206). Despite MSUS and clinical findings, there was no significant correlation between disease activity in psoriatic arthritis (DAPSA) and BUSES (p=0,549) or LEI (p=0,197). However, clinical and echographic scores (BUSES and LEI) were significantly associated (p=0.001). CONCLUSIONS: Our study proved a significant correlation between LEI and BUSES, although in literature the evidence is contrasting. This is probably due to the fact that the majority of the patients had high disease activity which made the clinical assessment similar to the US. Further studies on more numerous groups of patients have to be conducted in order to debate the inconsistencies related to clinical and US examinations in patients with PsA.

3 Tesla Magnetic Resonance Imaging Role in Articular Degenerative Pathology.

Osteoarthrosis is one of the most common degenerative diseases, affecting most of the middle and advanced age population. It is responsible for joint pain, and reduces mobility to functional impotence, thus becoming a public health problem. It is characterized by the destruction of articular cartilage and bone structures forming joints. Although osteoarthritis is considered a disease that occurs predominantly in the elderly, we present herein the case a young female patient, known for pelvic limb inequality and flat leg with advanced arthrosis in the left ankle, secondary to multiple surgical interventions performed at the lower limb. Because of the degenerative phenomena, the patient had reduced mobility, functional impairment and local pain. For the quantification and therapeutic management of degenerative changes produced by this pathology, magnetic resonance imaging (MRI) exploration technique is recommended, allowing visualization of alterations in bone structures and cartilage. This is the standard diagnosis method due to important details on bone structures and cartilages, even in the early stages of the disease. The importance of this case is suggested by the young age of the patient (28 years old) and the advanced stage of the degenerative phenomenon, being rare at this age.

Role of gadoxetic acid-enhanced 3T MRI combined with diffusion in small HCC diagnosis - case presentation.

We present the case of a patient with chronic viral hepatitis B and cirrhosis referred to the Gastroenterology Department for evaluation. The contrast-enhanced ultrasound and elastography revealed a nodule in the right liver lobe suggesting the diagnosis of dysplastic nodule. The patient performed contrast enhanced multi-detector computer-tomography, showing a subcapsular nodule with enhanced centre and lack of enhancement in the perifery, highly suspicious for HCC. The HCC final diagnosis was assessed by using 3T magnetic resonance imaging system along with hepatocyt specific contrast agents and diffusion sequences, pointing to the importance of state-of-the-art imaging techniques in the liver nodules assessment.

Magnetic resonance imaging criteria for thrombolysis in hyperacute cerebral infarction.

PURPOSE: Selection of patients with cerebral infarction for MRI that is suitable for thrombolytic therapy as an emerging application. Although the efficiency of the therapy with i.v. tissue plasminogen activator (tPA) within 3 hours after onset of symptoms has been proven in selected patients with CT, now these criteria are determined by MRI, as the data we gather are fast and accurate in the first hours. MATERIAL AND METHODS: MRI screening in patients with acute cerebral infarction before application of thrombolytic therapy was done in a UCC Mannheim in Germany. Unlike trials with CT, MRI studies demonstrated the benefits of therapy up to 6 hours after the onset of symptoms. We studied 21 patients hospitalized in Clinic of Neuroradiology at University Clinical Centre in Mannheim-Germany. They all undergo brain MRI evaluation for stroke. This article reviews literature that has followed application of thrombolysis in patients with cerebral infarction based on MRI. RESULTS: We have analyzed the MRI criteria for i.v. application of tPA at this University Centre. Alongside the personal viewpoints of clinicians, survey reveals a variety of clinical aspects and MRI features that are opened for further more exploration: therapeutic effects, the use of the MRI angiography, dynamics, and other. CONCLUSIONS: MRI is a tested imaging method for rapid evaluation of patients with hyperacute cerebral infarction, replacing the use of CT imaging and clinical features. MRI criteria for thrombolytic therapy are being applied in some cerebral vascular centres. In Kosovo, the application of thrombolytic therapy has not started yet.

Paradoxical Growth of Optochiasmatic Tuberculoma during the Treatment of Tuberculous Meningitis.

Intracranial brain parenchymal tuberculomas may form paradoxically, days to months after starting antituberculous drug therapy. They may develop in and around optic chiasm and optic nerves after antituberculous treatment as a quite rare occurrence in tuberculous meningitis (TBM) this may lead to severe visual loss if not treated properly. We describe a 5 year-old child with documented TBM being treated with first line antituberculous drugs which developed visual impairment 3 months after starting the treatment. MRI after gadolinium administration revealed multiple perichiasmatic ring enhancing lesions due to tuberculomas. Visual impairment developing in a patient on treatment with antituberculous drugs should give rise to a suspicion of rare optochiasmatic tuberculomas; this necessitates urgent contrast-enhanced MRI of the brain and prompt treatment with steroids.

Female pelvi-abdominal multilocular recurrent fluid collection of uncertain aetiology.

UNLABELLED: Recurrent pelvi-abdominal multilocular fluid collections in female patients may be of various aetiology: infections, haemorrhage, benign or malignant tumours. PURPOSE: Diagnosis of such fluid collections is complex, imaging examinations (ultrasonography, computed tomography, MRI) and biochemical, cytological and histological examinations must be included. Some cases, however, are difficult to diagnose, and their treatment is uncertain. MATERIALS AND METHODS: We present the case of a 22-year-old unmarried female patient with minor symptoms, not correlated with a pelvi-peritoneal fluid collection extending into the infra-mesocolic space, revealed by ultrasonography and MRI. The aetiology was uncertain after biological examinations and cytology. The disease course was recurrent during 14 months, under anti-inflammatory treatment and surgical intervention with removal of the fluid (2.5 l), resection of the right ovary (histological examination revealed small ovarian mucinous cysts) and excision of a fibroma of the right utero-sacral ligament. Follow-up sonography was the chosen method for repeated diagnostic and therapeutic echo-guided punctures. Finally, after immuno-stimulating treatment, we observed almost complete remission of the peritoneal fluid collection. RESULTS: This paper reveals significant discordances between the clinical appearance and the presence of a large peritoneal fluid collection, between locally recurrent appearance and cytological and histopathological "benign" results, between positive intradermal reaction to tuberculin and negative culture of B. Koch from aspirate. There were concordances between immune electrophoresis and some cytological elements and between three dimensional and panoramic SieScape ultrasonography and MRI. We must, however, note the superiority of MRI in the designation of anatomical findings and analysis of the histological structure. CONCLUSION: The importance of this case is derived from the atypical clinical appearance and course, with uncertain aetiology after complex imaging, biological and surgical explorations.

[Severe acute pancreatitis. Its management and experience]. / Pancreatitele acute grave. Conduita si experienta.

The authors examined a group of 91 cases of acute pancreatitis hospitalised and treated between 1992 and 1996, using multiparametric bioclinical scores like Ranson, Imrie, Apache II systems and morphological scores obtained through C.T., they have divided the examined group into patients with A.B.P. (acute benign pancreatitis)--59 (64.84%), who don't require exquisite therapeutical means, with positive healing and A.S.P.--32 (35.16%), who require a complex medico-surgical therapeutics with unforeseeable evolution and results. The purpose of the paper was the one of establishing a diagnostical and therapeutical strategy for the A.S.P. adequate to actual conceptions. The correct diagnosis of acute pancreatitis initially has been established at 59 (64.83%) and erroneous at 32 (36.13%) cases. The diagnosis of A.S.P. has been established in 32 (35.16%). The etiology has been lithiasic (biliary) for 31.25% and nonbiliary for 68.75% patients. The C.T. examination in the best way to diagnose necrosis and infections, to follow the evolution and especially the surgical indication, achieved by the authors in 30% of cases. The initial medical treatment has been fulfilled at all the patients and the surgical one at 29 (91.63%). There have been implemented explorer laparotomies in 33.33% cases, interventions on the pancreas in 72.66%, operations associated on the biliary ways 41.37%, necessity operations 13.8%, with different types of draining (conventional and open abdomen). The results have been taxed by locoregional complications in 72.41%, general complications in 44.51% and a general rate of decrease of 43.75%. It is recommended initial surgical abstention and gravity estimations, the reanimation of all A.S.P. for prevention and treatment of general complications, surgical treatment of A.S.P. complications. The A.S.P. treatment of biliary (lithiasic) etiology after two months and after C.T. to confirm inflammatory process remission.