Prognostic Factors for Surgically Managed Spontaneous Spinal Epidural Hematoma: A Single-Center Case Series of 18 Patients.

BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is a rare pathology, which carries a significant morbidity. OBJECTIVE: To review our institutional experience of surgically managed patients with SSEH, seeking to better understand clinical prognostic factors related to postoperative outcomes and thereby improve counseling of patients before treatment. METHODS: All patients who underwent surgical management of SSEH between September 2011 and 2021. Baseline and postoperative clinical and radiological characteristics are presented, including the American Spinal Injury Association grade (ASIA). Statistical analyses were performed using Stata 13.1. RESULTS: Eighteen patients were identified in total (11 male patients and 7 female patients) with a median age of 59.5 (range 3-83) years. The most common spinal region affected was cervicothoracic (33.3%). Limb weakness (94.4%) and urinary dysfunction (83.3%) represented the most common presenting symptoms. Preoperatively, the presence of spinal cord edema on imaging was associated with worse preoperative Medical Research Council (MRC) grade ( P = .033), female sex was associated with preserved saddle sensation ( P = .04), and patients receiving antiplatelet medication were associated with a higher risk of preoperative axial back pain ( P = .005). Higher postoperative MRC grade was associated with higher preoperative ASIA ( P = .012) and MRC grade ( P = .005), and preservation of saddle sensation ( P = .018). Postoperative improvements in axial back pain were associated with higher preoperative ASIA grade ( P = .035) and anticoagulation treatment ( P = .029). CONCLUSION: Neurosurgical intervention for SSEH yields positive outcomes and benefits patients. Patients with higher preoperative ASIA, MRC grade, and those presenting with preserved saddle sensation may experience further improved clinical outcomes after intervention.

Ultrasound assessment of elbow enthesitis in patients with seronegative arthropathies.

BACKGROUND: Enthesopathy is an evolving area for applied clinical research. MRI is the gold standard in the diagnosis of elbow joint pathology, but recent reports indicate that ultrasound imaging is more sensitive and accurate than MRI in detecting enthesopathy of the heels and knees. Too many patients are under-diagnosed and/or misdiagnosed because the early pathological changes of enthesitis in the different types of seronegative arthropathies are not detected. OBJECTIVES: This study was undertaken to describe the ultrasound features of elbow enthesitis in patients with seronegative arthropathies. METHODS: We studied 38 diseased elbows in 38 patients with spondyloarthropathies (26 men and 12 women, mean age 32 years). All had elbow enthesopathy without typical conventional radiographic findings. Patients with histories of degenerative changes and/or local steroid injections were excluded. An HDI 3000 ATL ultrasound machine was used with a 5-12 MHz linear transducer to examine the affected elbow joints. The elbows of 10 normal healthy individuals were examined as normal controls. The patients were examined in the supine position with the elbow flexed 30°-50°. Longitudinal and transverse scans were obtained of the radiohumeral joint, the ulnahumeral joint, and the olecranon fossa. Two independent observers unaware of the clinical diagnosis read the ultrasound images and assessed the collateral ligaments, intratendinous echogenicity, tendon calcification, tendon thickness, presence of fluid, synovial proliferation, and bony changes. The reliability of the sonographic images was assessed by review of video recordings of the ultrasound examinations. RESULTS: Ultrasound revealed loss of the fibrillar echopattern (100 %), lack of a homogenous pattern with loss of the tightly packed echogenic dots (100 %), peritendinous edema with flaring of the tendon margins (84.2 %), irregular fusiform tendon thickening (100 %), and hyperechoic intratendinous lesions with ill-defined focal defects (18.4 %). Ultrasound also detected intratendinous calcifications of both the common extensor and common flexor tendons (52.6 %). Bony erosions were seen at the tendon insertions into the lateral epicondyles (13.15 %). CONCLUSION: Ultrasonographic features of elbow enthesitis differed from those described in knee and heel enthesitis. Ultrasound clearly showed early signs of tendon calcification, tendon edema, peritendinitis, and bony entheseal erosions. However, in elbow enthesitis the early bone erosion was associated with bone marrow edema, and the common extensor tendon was diffusely thickened. Ultrasound is a reliable, reproducible bedside imaging procedure. It improves the documentation of disease activity, progression, and treatment responses in patients with spondyloarthropathies. We recommend its use for the diagnosis and post-treatment follow-up of patients with enthesitis and seronegative spondyloarthropathies.

High impact of FDG-PET/CT in diagnostic strategies for ovarian cancer.

BACKGROUND: Ovarian cancer has the highest mortality of all gynecologic malignancies. FDG-PET/CT was proven to be accurate for identification of primary ovarian tumors, regional lymph nodes, and distant metastases. PURPOSE: To evaluate ovarian masses at FDG-PET/CT in correlation with histopathologic findings. MATERIAL AND METHODS: Ninety-eight patients underwent whole body FDG-PET/CT examination. Eighty-six patients with primary ovarian cancer and 12 patients with metastatic disease to the ovaries were included. RESULTS: PET/CT imaging was true-positive in 87/94 patients with malignant tumors. In 4/4 patients with benign tumors, PET/CT results were true-negative, with sensitivity of 92.6%, specificity 100%, total test accuracy 92.9%. Fifty-seven patients were diagnosed as stage IV ovarian cancer with distant metastasis. CONCLUSION: The anatomical/functional examination by FDG-PET/CT was proven to be valuable in increasing the diagnostic accuracy that can help improve patient management.

Significance of phentolamine redosing during prostaglandin E1 penile color Doppler ultrasonography in diagnosis of vascular erectile dysfunction.

Recently, it was reported that phentolamine redosing during penile duplex can abolish a false diagnosis of venous leakage in patients with impotence. The aim of this study is to identify any useful role of phentolamine redosing in diagnosis of venogenic impotence. Sixty-seven consecutive patients complaining of weak erection for at least 6 months were included in this study. Penile color Doppler ultrasound (CDU) was performed using a 7.5 MHz linear array transducer with a color flow mapping capability. Following intracavernous injection of 20 microg prostaglandin E1 (PGE1), all patients with persistent end diastolic velocity (EDV) >5 cm/sec with an erectile response of E3 or lower, 20 min after intracavernosal injection of PGE1, were asked to revisit our clinic for a second CDU, 2 weeks later. During initial CDU examination, all 67 patients experienced poor response to 20 microg PGE1 with their average peak systolic velocity (PSV) and EDV being 42.8 and 6.6 cm/sec, respectively. The second CDU examination had similar results to the first one. Addition of 2 mg phentolamine did not significantly change the PSV and EDV of cavernosal arteries in any of the 67 patients. In conclusion, addition of intracavernous phentolamine during PGE1 CDU examination carries no advantage over the use of PGE1 alone regarding cavernosal artery response in patients with suspected venogenic EDV.

Ultrasound detection of heel enthesitis: a comparison with magnetic resonance imaging.

OBJECTIVE: Seronegative arthropathies are associated with inflammatory enthesopathy. The involvement of Achilles tendon and plantar aponeurosis is common, with strong tendency toward fibrosis and calcification. This study tests the diagnostic efficacy of ultrasound (US) in depicting enthesitis, and compares sonographic images with magnetic resonance images (MRI). METHODS: We studied 32 patients with a diagnosis of seronegative arthropathies, 22 men, 10 women, mean age 29 years. They had heel enthesopathy without typical conventional radiographic evidence. T1 and T2 weighted and short-tau inversion recovery (STIR) MRI sequences were obtained in axial and sagittal planes. An HDI 3000 ATL US device equipped with 12 MHz linear transducer was used to examine the enthesis. Three independent observers assessed the reliability of sonographic images by using video recording of the US examinations. RESULTS: US images of enthesitis showed loss of normal fibrillar echotexture of tendon (100%), lacking the homogeneous pattern, with blurring of tendon margins (56.2%) and irregular fusiform thickening (84.3%). The affected tendons showed intratendinous lesions with ill defined focal tendon defects filled with a mixture of fluid, fat, and/or granulation tissue, with loss of their tightly packed echogenic dots. MRI showed tendon enlargement (62.5%) with loss of the normal flattened hypointense appearance, focal thickening and rounded configuration at the insertion site (31.2%), intermediate T1 and high T2 signals, and diminished signals within the pre-Achilles fat pad due to inflammatory edema. Among all patients, 40.6% developed osteitis. CONCLUSION: MRI was not sensitive compared to US in detecting early changes of enthesopathy. Fatty degeneration appeared late in MRI, while it was detected earlier using US. MRI was not able to detect any calcification process at the insertion site, while US images clearly showed the very early signs of the calcification process. We recommend use of US for early diagnosis and in treatment and followup of patients with tendon enthesopathy, to accurately identify and diagnose different pathologic and biomechanical changes.