Pulmonary Manifestations of Systemic Lupus Erythematosus

Pulmonary involvement is more common in systemic lupus erythematosus (SLE) than in any other connective tissue disease, and more than half of patients with SLE suffer from respiratory dysfunction during the course of their illness. Although sepsis and renal disease are the most common causes of death in SLE, lung disease is the predominant manifestation and is an indicator of overall prognosis. Respiratory disease may be due to direct involvement of the lung or as a secondary consequence of the effect of the disease on other organ systems.

The Relation between Mastoid Pneumatization and Sigmoid Sinus Position in Chronic Otomastoiditis

PURPOSE: If significantly influenced by chronic otomastoiditis(COM), mastoid pneumatization and the position of the sigmoid sinus affect the operative procedure and postoperative complications in middle ear surgery. We evaluated mastoid pneumatization and sigmoid sinus position, and their relationship in COM, especially its during onset. MATERIALS AND METHODS: Using temporal bone CT and referring to any relevant medical records, we retrospect+tively analyzed 107 cases of COM and 49 cases of normal ear. The total case load comprised an adult group, aged above 16 years [100 cases of COM (M:F=46:54, mean age = 45 years), and 42 cases of normal ear,(M:F=20:22, mean age = 44 years)], and a childhood group, aged less than 16 years [7 cases of COM (M:F=4:3, mean age = 8.4 years), and 7 cases of normal ear (M:F=4:3, mean age = 7 years)]. We determined the thickness of the mastoid bone by measuring the shortest distance between the outer cortex of this bone and the deepest border of the sigmoid sinus; the depth of the sigmoid sinus; and the degree of mastoid pneumatization and sclerosis. Fifty-three patients whose medical history clearly included the onset of otomas-toiditis were divided into a child-onset group and an adult-onset group, and the relationship between the onset of otomastoiditis and the thickness of the mastoid bone was compared between the two groups. RESULTS: The mean axial thickness of the mastoid bone was 9.672 <+/-2.745 mm in COM and 12.430 +/-3.027 mm in normal ear. The difference was statisfically significant (p < 0.0001). The mean depth of the sigmoid sinus was 7.557 +/-1.868 mm in COM and 7.591 +/-2.315 mm in normal ear, with no statistically significant difference. In the childhood group, the mean axial thickness of the mastoid bone was 8.672 +/-2.978 mm in COM and 11.778 +/-3.087 mm in normal ear. This difference was statistically significant (p < 0.05). In the adult group, the corresponding figures were 9.742 +/-2.731 mm in COM and 12.538 +/-3.041 mm in normal ear, a dif-ference which was also statistically significant (p < 0.0001). Among patients with an obvious history of COM, child-onset cases totalled 24 (mean axial thickness of the mastoid bone, 9.2.0 +/-2.158 mm), while there were 29 adult-onset cases (mean axial thickness, 10.08 +/-2.99 mm). This difference in thickness between child-onset and adult-onset COM was statistically significant (p < 0.05). CONCLUSION: In COM, the degree of mastoid pneumatization is proportional to the axial thickness of the mastoid bone, and inversely proportional to the degree of sclerosis, anterior location of the sigmoid sinus and the onset of COM. If the sigmoid sinus is properly located, COM may inhibit mastoid pneumatization.

MR Findings of Bland and Proliferative Joint Effusion in Knee Joint

PURPOSE: To determine the MR imaging criteria by which bland and proliferative effusion of the knee may be differentiated. MATERIALS AND METHODS: We retrospectively reviewed the MR images of 64 patients (65cases), in whom T2-weighted sagittal scans revealed anteroposterior distension of the suprapatellar bursa of at least 0.5cm. The patients were divided into two groups: bland effusion (n=36) , and proliferative effusion [(n=29); pigmented villonodular synovitis (n=5), rheumatoid arthritis (n=6), septic arthritis (n=6), chronic synovitis (n=5), gouty arthritis (n=3), tuberculous arthritis (n=2), and lipoma arborescens (n=2)]. All conditions were diagnosed on the basis of operative data or clinical criteria. The knee joint space was divided into four compartments: the suprapatellar pouch, central zone, posterior femoral recess, and subpopliteal recess, and the amount and distribution of effusion was then compared between the two groups. The ratios of the width and the length of the lateral recess of the suprapatellar bursa to those of its medial recess were deter mined, and the findings for the two groups were compared. Abnormality of the intracapular fat pads (prefemoral fat, Hoffa 's fat, and quadriceps fat sign) as seen on sagittal scans, is a predictor proliferative effusion, and any such abnormality was evaluated. The synovium was classified as either thin or thick, and as having either a smooth or an irregular margin, as seen on Gadolinium-enhanced T1W1 images. RESULTS: As compared with bland effusion, proliferative effusion involved more prominent joint effusion in the suprapatellar pouch and posterior femoral recess, and in the suprapatellar bursa, the ratio of the width of the lateral recess to that of the medial recess was greater. When comparing the ratio of the length of the lateral recess to that of the medial recess, however, no significant statistical difference was noted. Sensitivity: specificity for proliferative effusion was 58%: 86% on coronal scan and 64%: 93% on axial scan at a threshold value of 0.7 (the ratio of the width). The prefemoral fat pad sign was 41% sensitive and 100% specific, while Hoffa 's fat pad sign had a sensitivity of 32% and a specificity of 95%. The corresponding figures for the quadriceps fat pad sign were 14% and 100%. The pattern of the synovium in bland effusion was thin and smooth in two, thick and smooth in one, and thin and irregular in one. In proliferative effusion, the pattern was thick and smooth in 11 cases, thin and irregular in four, and thick and irregular in 14. CONCLUSION: In proliferative effusion, the synovium tended to be thick and irregular. Proliferative effusion demonstrated greater predilection for the suprapatellar pouch, especially the lateral recess, and posterior femoral recess, than did bland effusion. Difference in the distribution of joint effusion effectively predict both proliferative effusion as well as intracapsular fat pad signs.