Classification of temporomandibular joint erosion, arthritis, and inflammation in patients with juvenile idiopathic arthritis.

INTRODUCTION: Juvenile idiopathic arthritis is the most common disease in pediatric rheumatology. It is characterized by chronically progressive joint destruction. The temporomandibular joints (TMJs) are involved in up to 87% of patients and may take an asymptomatic course in 69% of cases. Other than contrast-enhanced magnetic resonance imaging (MRI), there are no reliable screening symptoms or non-invasive procedures available to diagnose the inflammation in its acute form. The goal of this study was to establish an imaging-based classification system for TMJ erosion via MRI and cone-beam computed tomography (CBCT) in an effort to improve indication-specific treatment approaches and to facilitate the comparison of findings. MATERIALS AND METHODS: A total of 46 patients were included. Contrast-enhanced MRI and CBCT images obtained during treatment by pediatric rheumatologists and orthodontists were available from 23 patients with juvenile idiopathic arthritis. We devised a classification system combining the findings of both imaging techniques based on this patient sample in comparison with CBCT findings from an age- and gender-matched group of 23 non-arthritis patients, taking into consideration the available literature and administration of contrast medium. RESULTS: Our cohort of 46 patients comprised 60% female and 40% male patients with a mean age of 14 years, providing a total of 92 TMJs for evaluation. We were able to apply the findings efficiently and conveniently to this classification system with no relevant interobserver differences. Mild structural abnormalities were noted in 21% of TMJs in the control group, whereas 83% of TMJs in the arthritis group exhibited severe anomalies, including cases of extreme destruction. Age and gender did not affect the degree of destruction significantly. CONCLUSION: This is the first classification system to link CBCT and MRI with the use of contrast medium. Contrast-enhanced MRI is an internationally recognized technique that permits acute inflammation to be unequivocally diagnosed. Although structural erosion of the TMJs in our arthritis group was generally severe and significant, we were surprised to observe some cases that were clinically asymptomatic.

Precision of cephalometric analysis via fully and semiautomatic evaluation of digital lateral cephalographs.

OBJECTIVES: The aim of this study was to evaluate the precision of the cephalometric analysis using the orthodontic software Orthometric((R)) in two modes: fully automatic without any help by the user and semiautomatic with manual determination of all cephalometric landmarks. METHODS: From 100 indirectly digitally produced cephalographs, 72 were chosen randomly. On each one of these, three methods were applied on 12 decision-relevant cephalometric angles according to Hasund/Segner: (1) hand drawing on a transparent sheet over the cephalographic film; (2) software semiautomatically with manual correction on the screen; and (3) fully automatically. The hand-based method (1) is well established as a quality standard and reference. The angle measurement results of this method were compared with those of the semiautomatic and the fully automatic method by calculation of the mean absolute differences. Additionally, five randomly chosen cephalographs were evaluated ten times using all three methods for statistical evaluation of reproducibility. RESULTS: At tenfold evaluation of five cephalographs, the standard deviations of the angles were between 0.05 degrees and 0.8 degrees . These results were similar using all three methods. All three methods had similar reproducibility. At evaluation of 72 cephalographs, the mean absolute angle differences between the hand-based (1) and semiautomatic (2) methods were below 2 degrees and so within the allowed tolerance limit, except for the nasolabial angle. In contrast to this, all mean absolute angle differences between the (1) hand-based and (3) fully automatic methods exceeded 2 degrees , and with this the tolerance limit allowed by literature. CONCLUSIONS: The fully automatic determination of the cephalometric landmarks has led to relevant errors up to now, so that it is mandatory to check all automatically set landmarks and to correct them if required. In the case of the semiautomatic method, all relevant angles can be determined with the same reliability as hand drawing.

Temperament and character inventory and pharmacotherapeutic outcome in bulimia nervosa.

OBJECTIVE: To assess the relationship between the personality dimensions measured by the temperament and character inventory (TCI) and pharmacotherapeutic outcome in bulimia nervosa (BN). METHODS: Thirty female BN patients aged 19.5+/-2.9 years were enrolled to receive 12 weeks' treatment with fluoxetine or buspirone and assessed using the Polish version of the TCI. The personality dimensions of the patients with good and poor treatment responses were compared. RESULTS: The subjects with a good outcome had a higher self-directedness and lower harm avoidance score; this difference was more pronounced in the fluoxetine-treated subjects. At multiple regression analysis, only self-directedness predicted a good outcome. DISCUSSION: The results indicate that self-directedness is associated with a good pharmacotherapeutic outcome in BN. This seems to confirm the results of previous studies of the pharmacotherapy of depression and cognitive-behavioural therapy (CBT) in BN.