IgG4-Related Dacryoadenitis in Egyptian Patients: A Retrospective Study.

Purpose: To report clinical, serological, and histopathological findings in Egyptian patients with dacryoadenitis associated with ImmunoglobulinG4-related disease (IgG4-RD). Methods: We retrospectively revised medical records of patients presented to Al-Azhar University Hospitals with lacrimal gland (LG) swelling between June 2016 and February 2022. We included patients with definite IgG4-related disease (IgG4-RD) diagnosis and excluded those with possible, probable, or unlikely IgG4-RD based on The Japanese Ministry of Health, Labour, and Welfare's 2011 guidelines. Results: Sixteen cases were included in the study (Fourteen females and two males, mean age 39.2±12.2 years); Seven cases met the criteria of Mikulicz disease, and nine cases met full clinical, serological, and histopathological criteria. Mean reported serum IgG was 1792.5 ± 313.7 (range 1063-2134) mg/dl, mean serum IgG4 was 576.25±215.3 (range 112-841) mg/dl, and mean Serum IgG4/IgG ratio was 31.9 ± 12.4%. The mean number of IgG4+ plasma cells/HPF was 74 ± 21.2, and the mean IgG4+ plasma cell percentage was 55 ± 9.7%. Serum IgG4 level showed a positive correlation to tissue IgG4+plasma cell percentage, while serum IgG4/IgG ratio positively correlated to both percentage and number of IgG4+plasma cells. Steroids had a good initial response, but recurrences were common. Conclusion: A considerable proportion of patients with lacrimal gland swelling fall within the range of IgG4-RD. Proper diagnosis requires clinical, serological, and histopathologic correlation. Patients require long follow-up periods.

A single simple position for ultrasound assessment of both common extensor and common flexor origin at the elbow.

OBJECTIVE: Is to evaluate the simplicity of 90° flexion/neutral position for ultrasonography assessment of both common extensor and common flexor origins in comparison with the standard position. MATERIAL AND METHODS: A standard questionnaire was distributed on 50 trainees, rheumatologists with No previous experience or training in ultrasonography. (They) were attending musculoskeletal training workshops at AL-Azhar rheumatology department musculoskeletal ultrasonography unit in 2016. Each participant then (was) asked to practice US examination of both common extensor and common flexor origins in both positions and then fill four questionnaires, two (of which are) for common flexor and (the other) two (are) for the common extensor origins, in the standard and the other proposed single position. Each questionnaire (whose) answer was graded on scale from 0 to 10, includes the following points: • Time needed to examine the tendon in minutes, • Difficulty in maintaining the probe contact to the skin, • Difficulty in getting good image of the tendon, • The overall impression of simplicity. RESULTS: Descriptive analysis of the questionnaire results shows that the participants favors the single position in all questionnaire parameters. Comparing means of the four questionnaire parameters in both positions shows highly significant difference in the four parameters at the level of both common flexor and extensor origins in favor of the single position as p > 0.005. CONCLUSION: The 90 degree flexion/neutral position appears to be simpler than the standard position for ultrasonography assessment of common extensor and common flexor tendons at the elbow.

A single simple position for ultrasound assessment of both common extensor and common flexor origin at the elbow

Abstract Objective: Is to evaluate the simplicity of 90° flexion/neutral position for ultrasonography assessment of both common extensor and common flexor origins in comparison with the standard position. Material and methods: A standard questionnaire was distributed on 50 trainees, rheumatologists with No previous experience or training in ultrasonography. (They) were attending musculoskeletal training workshops at AL-Azhar rheumatology department musculoskeletal ultrasonography unit in 2016. Each participant then (was) asked to practice US examination of both common extensor and common flexor origins in both positions and then fill four questionnaires, two (of which are) for common flexor and (the other) two (are) for the common extensor origins, in the standard and the other proposed single position. Each questionnaire (whose) answer was graded on scale from 0 to 10, includes the following points: Time needed to examine the tendon in minutes, Difficulty in maintaining the probe contact to the skin, Difficulty in getting good image of the tendon, The overall impression of simplicity. Results: Descriptive analysis of the questionnaire results shows that the participants favors the single position in all questionnaire parameters. Comparing means of the four questionnaire parameters in both positions shows highly significant difference in the four parameters at the level of both common flexor and extensor origins in favor of the single position as p > 0.005. Conclusion: The 90 degree flexion/neutral position appears to be simpler than the standard position for ultrasonography assessment of common extensor and common flexor tendons at the elbow.