Stromal-derived IGF2 promotes colon cancer progression via paracrine and autocrine mechanisms.

The insulin-like growth factor (IGF)2/IGF1 receptor (IGF1R) signaling axis has an important role in intestinal carcinogenesis and overexpression of IGF2 is an accepted risk factor for colorectal cancer (CRC) development. Genetic amplifications and loss of imprinting contribute to the upregulation of IGF2, but insufficiently explain the extent of IGF2 expression in a subset of patients. Here, we show that IGF2 was specifically induced in the tumor stroma of CRC and identified cancer-associated fibroblasts (CAFs) as the major source. Further, we provide functional evidence that stromal IGF2, via the paracrine IGF1R/insulin receptor axis, activated pro-survival AKT signaling in CRC cell lines. In addition to its effects on malignant cells, autocrine IGF2/IGF1R signaling in CAFs induced myofibroblast differentiation in terms of alpha-smooth muscle actin expression and contractility in floating collagen gels. This was further augmented in concert with transforming growth factor-ß (TGFß) signaling suggesting a cooperative mechanism. However, we demonstrated that IGF2 neither induced TGFß/smooth muscle actin/mothers against decapentaplegic (SMAD) signaling nor synergized with TGFß to hyperactivate this pathway in two dimensional and three dimensional cultures. IGF2-mediated physical matrix remodeling by CAFs, but not changes in extracellular matrix-modifying proteases or other secreted factors acting in a paracrine manner on/in cancer cells, facilitated subsequent tumor cell invasion in organotypic co-cultures. Consistently, colon cancer cells co-inoculated with CAFs expressing endogenous IGF2 in mouse xenograft models exhibited elevated invasiveness and dissemination capacity, as well as increased local tumor regrowth after primary tumor resection compared with conditions with IGF2-deficient CAFs. In line, expression of IGF2 correlated with elevated relapse rates and poor survival in CRC patients. In agreement with our results, high-level coexpression of IGF2 and TGFß was predicting adverse outcome with higher accuracy than increased expression of the individual genes alone. Taken together, we demonstrate that stroma-induced IGF2 promotes colon cancer progression in a paracrine and autocrine manner and propose IGF2 as potential target for tumor stroma cotargeting strategies.

Autocrine WNT2 signaling in fibroblasts promotes colorectal cancer progression.

The canonical WNT signaling pathway is crucial for intestinal stem cell renewal and aberrant WNT signaling is an early event in colorectal cancer (CRC) development. Here, we show for the first time that WNT2 is one of the most significantly induced genes in CRC stroma as compared to normal stroma. The impact of stromal WNT2 on carcinoma formation or progression was not addressed so far. Canonical WNT/ß-catenin signaling was assessed using a 7TGP-reporter construct. Furthermore, effects of WNT2 on fibroblast migration and invasion were determined using siRNA-mediated gene silencing. Tumor cell invasion was studied using organotypic raft cultures and in vivo significance was assessed via a xenograft mouse model. We identified cancer-associated fibroblasts (CAFs) as the main source of WNT2. CAF-derived WNT2 activated canonical signaling in adenomatous polyposis coli/ß-catenin wild-type colon cancer cells in a paracrine fashion, whereas no hyperactivation was detectable in cell lines harboring mutations in the adenomatous polyposis coli/ß-catenin pathway. Furthermore, WNT2 activated autocrine canonical WNT signaling in primary fibroblasts, which was associated with a pro-migratory and pro-invasive phenotype. We identified FZD8 as the putative WNT2 receptor in CAFs. Three-dimensional organotypic co-culture assays revealed that WNT2-mediated fibroblast motility and extracellular matrix remodeling enhanced cancer cell invasion of cell lines even harboring mutations in the adenomatous polyposis coli/ß-catenin pathway. Thus, suggesting a tumor-promoting influence on a broad range of CRC. In line, WNT2 also promotes tumor growth, invasion and metastasis in vivo. Moreover, high WNT2 expression is associated with poor prognosis in human CRC. The identification of the pro-malignant function of stromal derived WNT2 in CRC classifies WNT2 and its receptor as promising stromal targets to confine cancer progression in combination with conventional or targeted therapies.

Does MIPO of fractures of the distal femur result in more rotational malalignment than ORIF? A retrospective study.

PURPOSE: Intraoperative control of rotational malalignment poses a big challenge for surgeons when using modern MIPO (minimally invasive plate osteosynthesis) techniques. We hypothesized that distal femoral fractures treated with MIPO technique are more often fixed in malrotation than those treated with open reduction internal fixation (ORIF). METHODS: In this retrospective study, we identified 20 patients who met the inclusion criteria and agreed to take part in the study. In ten patients MIPO was applied, in the other ten ORIF was used. Mean age was 44.8 (19-71 years). Functional status was assessed using clinical scores (Harris Hip Score, WOMAC Hip, KS Score, WOMAC Knee, Kujala Score). Rotational alignment was assessed with magnetic resonance imaging and compared to the opposite leg. RESULTS: We discovered a significant difference in the mean rotational difference between the MIPO group (14.3°) and the ORIF group (5.2°). Functionally, patients in the ORIF group outperformed patients in the MIPO group in all clinical scoring systems although no one proved to be statistically significant. MIPO technique was associated with significantly more rotational malalignment compared to ORIF in distal femur fracture fixation. However, implant failure and nonunion was more common in the ORIF group, with a revision rate of 3 versus 1 in the ORIF group. Clinical scoring did not significantly different between both groups. CONCLUSION: Taking into account the undisputable advantages of minimally invasive surgery, improved teaching of methods to avoid malrotation as well as regular postoperative investigations to detect any malrotation should be advocated.

IGFBP7, a novel tumor stroma marker, with growth-promoting effects in colon cancer through a paracrine tumor-stroma interaction.

The activated tumor stroma participates in many processes that control tumorigenesis, including tumor cell growth, invasion and metastasis. Cancer-associated fibroblasts (CAFs) represent the major cellular component of the stroma and are the main source for connective tissue components of the extracellular matrix and various classes of proteolytic enzymes. The signaling pathways involved in the interactions between tumor and stromal cells and the molecular characteristics that distinguish normal 'resting' fibroblasts from cancer-associated or '-activated' fibroblasts remain poorly defined. Recent studies emphasized the prognostic and therapeutic significance of CAF-related molecular signatures and a number of those genes have been shown to serve as putative therapeutic targets. We have used immuno-laser capture microdissection and whole-genome Affymetrix GeneChip analysis to obtain transcriptional signatures from the activated tumor stroma of colon carcinomas that were compared with normal resting colonic fibroblasts. Several members of the Wnt-signaling pathway and gene sets related to hypoxia, epithelial-to-mesenchymal transition (EMT) and transforming growth factor-ß (TGFß) pathway activation were induced in CAFs. The putative TGFß-target IGFBP7 was identified as a tumor stroma marker of epithelial cancers and as a tumor antigen in mesenchyme-derived sarcomas. We show here that in contrast to its tumor-suppressor function in epithelial cells, IGFPB7 can promote anchorage-independent growth in malignant mesenchymal cells and in epithelial cells with an EMT phenotype when IGFBP7 is expressed by the tumor cells themselves and can induce colony formation in colon cancer cells co-cultured with IGFBP7-expressing CAFs by a paracrine tumor-stroma interaction.

[Arthroscopically assisted osteosynthesis of dorsally tilted intraarticular distal radius fractures--technique and results]. / Arthroskopisch assistierte Versorgung dorsal dislozierter distaler intraartikulärer Speichenfrakturen--Technik und Ergebnisse.

The present paper describes the indication and application of an arthroscopically assisted osteosynthesis for distal radius fractures. Visualisation of articular incongruency is emphasised with special regard to articular fracture fragment reduction. In addition to that, classification of soft tissue injuries and treatment options are discussed. The final clinical and radiological results of 17 patients are presented: DASH and PRWE averaged 4.9 and 6.0 respectively. Active range of motion measured 123° for flexion/extension, 51° for radial and ulnar deviation and 163° for pronosupination, which is 87%, 98% and 97%, respectively, compared with the opposite wrist. Radial inclination at final follow-up was 23°, palmar tilt measured 6° and ulnar variance averaged -1.2 mm. The scapholunate gap at follow-up was 1.6 mm, and the scapholunate angle measured 57°.

Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging.

OBJECTIVE: To find and evaluate characteristic magnetic resonance imaging (MRI) patterns for the differentiation between Ewing sarcoma and osteomyelitis. MATERIALS AND METHODS: We identified 28 consecutive patients referred to our department for MRI (1.5 T) of an unclear bone lesion with clinical symptoms suggestive of Ewing sarcoma or osteomyelitis. MRI scans were re-evaluated by two experienced radiologists, typical MR imaging features were documented and a diagnostic decision between Ewing sarcoma and osteomyelitis was made. Statistical significance of the association between MRI features and the biopsy-based diagnosis was assessed using Fisher's exact test. RESULTS: The most clear-cut pattern for determining the correct diagnosis was the presence of a sharp and defined margin of the bone lesion, which was found in all patients with Ewing sarcoma, but in none of the patients with osteomyelitis (P < 0.0001). Contrast enhancing soft tissue was present in all cases with Ewing sarcoma and absent in 4 patients with osteomyelitis (P = 0.0103). Cortical destruction was found in all patients with Ewing sarcoma, 4 patients with osteomyelitis did not present any cortical reaction (P = 0.0103). Cystic or necrotic areas were identified in 13 patients with Ewing sarcoma and in 1 patient with osteomyelitis (P = 0.004). Interobserver reliability was very good (kappa = 1) in Ewing sarcoma and moderate (kappa = 0.6) in patients with osteomyelitis. CONCLUSIONS: A sharp and defined margin, optimally visualized on T1-weighted images in comparison to short tau inversion recovery (STIR) images, is the most significant feature of Ewing sarcoma in differentiating from osteomyelitis.

Lateral cephalometric analysis of mandibular morphology: discrimination among subjects with and without temporomandibular joint disk displacement and osteoarthrosis.

To assess whether in patients with temporomandibular joint (TMJ) arthralgia cephalometric variables of mandibular morphology may discriminate among the magnetic resonance (MR) imaging-based TMJ groups of 'bilateral presence of disk displacement without reduction (DDwoR) and osteoarthrosis (OA)' and 'bilateral absence of bilateral DDwoR and OA'. Bilateral MR imaging of the TMJ was performed in 45 consecutive TMJ arthralgia patients to identify individuals with the specific structural characteristics of bilateral TMJ DDwoR associated with OA. Linear and angular cephalometric measurements were taken from lateral cephalograms to apply selected criteria of mandibular morphology. A discriminant function analysis was used to investigate how cephalometric parameters discriminate among the TMJ groups of 'bilateral presence of DDwoR with OA' and 'bilateral absence of DDwoR and OA'. Ramus height (Ar-Go) and effective mandibular length (Ar-Pog) produced a significant discriminant function that predicted TMJ group membership (P < 0·001). This function correctly classified 80·2% of original and cross-validated grouped cases. This study supports the concept that cephalometric variables of mandibular morphology discriminate among subjects with and without bilateral TMJ DDwoR and OA.

Intraorbital plexiform neurofibroma in an NF-1-negative patient.

A 52-year-old patient presented with an orbital swelling and exophthalmos that enlarged over a period of about 40 years. The clinical examination showed massive exophthalmos and ptosis of the right eye without diplopia. The radiological investigation (MRI, CT and ultrasound) showed an unclear intraorbital mass with erosion of the orbital floor, infraorbital rim and orbital roof. The lesion was diagnosed histologically as a plexiform neurofibroma. The patient did not present any features of neurofibromatosis type 1 (NF-1) and molecular genetic analysis was unable to uncover a pathogenic sequence alteration in the NF-1 gene. Owing to the absence of clinical and ophthalmologic symptoms and the improbability of complete removal, the patient refused surgical intervention.

[Distal radius fractures--aetiology, treatment and outcome]. / Distale Radiusfrakturen--Atiologie, Behandlungsmethoden und Ergebnisse.

INTRODUCTION: Distal radius fractures were investigated in a retrospective open multicenter cohort study to assess aetiology, fracture pattern and treatment modalities and their influence on subjective and objective outcome. PATIENTS AND METHOD: Demographic data, fracture history, course of fracture healing, functional and radiological parameters and the DASH-questionnaire were collected from 18 Austrian hospitals and analysed statistically. PATIENTS: n = 707, 465 (65.8 %) female, 242 (34.2 %) male. Mean age: 52 (19 - 86) years; age group 1 (19 - 39 years) 26 %, age group 2 (40 - 59 years) 41 %, age group 3 (60 years and elder) 33 %. FOLLOW-UP: mean 5.8 (3.9 - 17) years; HISTORY: fall 65.1 %, sports 17.4 %, traffic accidents 8.9 %, fall from great height 7.5 %; others 1.1 %. Most frequent fracture patterns according to AO: A2 (26.6 %), C2 (22.2 %), A3 (16.1 %), C1 (12.7 %); according to PE: I-2 (44.8 %), I-1 (40.0 %), III-2 (4.4 %), II-2B (4 %). There was no significant correlation between fracture pattern and age groups for both fracture classifications. TREATMENT: 57.9 % surgical, 42.1 % conservative. Radiological results: Depending on treatment, there were significant differences between the radial tilt and the palmar radial inclination, the dorsal and palmar ulnar variance and the width of the DRU-joint. DASH-questionnaire: Median 6.03 (90 - 0). There was a significant, minor positive correlation of bad results in the elderly and a minor positive correlation of bad results correlated to the palmar radial inclination as well as a minor negative correlation to the palmar DRUJ-value and the ulnar variance. CONCLUSION: The incidence of distal radius fractures was increased in females and in patients with the age between 40 - 59 years. The most frequent cause to sustain a distal radius fracture was a simple fall. 85 % of the fractures were dislocated dorsally. The most frequent fracture type was the dorsal intraarticular. There was no specific fracture type observed to be typical for one of the age groups and surgical treatment was almost as frequent as conservative. Surgical treatment improved reconstruction of the radial tilt, palmar inclination and the DRU-joint. Subjective outcome was worse in elderly patients. The radiological changes in the DRU-joint correlated to minor DASH values.

[MR imaging for the evaluation of accompanying injuries in cases of distal forearm fractures in children and adolescents]. / MRT zur Beurteilung von Begleitverletzungen distaler Unterarmbrüche im Wachstumsalter.

INTRODUCTION: The study was made to evaluate the role of MR imaging in pediatric distal forearm fractures by comparison with the findings of plain radiographs and MRI. MATERIAL AND METHOD: 38 patients (27 boys and 11 girls, mean age of 12 years, range 7 to 15 years) with radiographically open distal radius and ulna growth plates requiring first aid for a fracture of the distal third of the forearm, were included in this study. The fractures were diagnosed on plain radiographs and conservative treatment was performed. In 35 patients MR imaging was performed within 3 weeks after the accident and in 3 patients MRI was performed after 6 to 9 weeks because of persistent wrist pain. RESULTS: Fifteen Salter/Harris II injuries of the radius and 1 of the ulna, 1 torus fracture of the radius and 2 of the ulna, 12 greenstick fractures of the radius and 3 of the ulna, 10 complete displaced radius fractures and 15 ulnar styloid fractures were found on plain radiographs. Twelve patients had evidence of associated triangular fibrocartilage complex (TFCC) lesions in MRI, there was no statistical correlation between TFCC lesions and fracture types, fracture dislocations or patients age (p > 0.5). One patient had an avulsion of the radioscaphocapitate ligament from the radius accompanying a greenstick fracture of the distal radius. 19 bone bruises and two radiographically occult fractures were identified. In 2 patients, a bone marrow oedema was seen in the radial epiphysis immediately adjacent to the germinal zone of the growth plate. In these patients premature physeal arrest occurred. CONCLUSION: MRI plays an important role in the evaluation of acute pediatric wrist injuries. It allows a better evaluation of osseous lesions than plain radiographs. In our study, a tear of the triangular fibrocartilage complex accompanied distal radius fractures in 32 % of patients. Simultaneous rupture of the TFCC insertion in the fovea ulnaris and ulnar styloid fracture lead to destabilisation of the distal radioulnar joint (DRUJ).

Conjoined epigastric heteropagus twins: excision of a parasitic twin from the anterior abdominal wall of her sibling.

Epigastric heteropagus twins (EHT) are an exceedingly rare form of asymmetric conjoined twins in whom the dependent twin (parasite) is attached to the right or left upper abdomen of the dominant part (autosite). Such a case observed at our institution with 34 month follow-up is presented here and the surgical technique described. A magnetic resonance imaging (MRI)-supported surgical separation of the parasite with successful closure of the abdominal wall defect of the autosite was performed. Follow-up studies showed an autosite which was alive and in optimal health. A comprehensive review including data from English and non-English literature is presented.

Condylar injury: magnetic resonance imaging findings of temporomandibular joint soft-tissue changes.

Recent studies have suggested magnetic resonance imaging (MRI) as useful in the evaluation of soft-tissue changes that occur in the temporomandibular joint (TMJ) after acute condylar trauma. The aim of this study was to investigate whether MRI findings of disc displacement, capsular tear and haemarthrosis are linked to the degree of condylar injury. Nineteen patients were assigned a diagnosis of uni- or bilateral condylar fracture (n=17), or condylar contusion with a uni- or bilateral diagnosis of TMJ sprain/strain (n=2). Condylar injuries were classified as grade I (absence of condylar fracture), grade II (type I, II or III condylar fracture), and grade III (type IV, V or VI condylar fracture). Bilateral sagittal and coronal MR images were obtained immediately after injury to establish the presence or absence of disc displacement, haemarthrosis and capsular tear. The data revealed a significant relationship between the degree of condylar injury and the MRI findings of capsular tear (P=0.000) and haemarthrosis (P=0.000), and between the MRI diagnoses of capsular tear and haemarthrosis (P=0.000). There was good diagnostic agreement between the presence of grade III condylar injury and the MRI diagnoses of capsular tear (K=0.62) and haemarthrosis (K=0.60). The results suggest that degree of condylar injury is related to MRI findings of capsular tear and haemarthrosis, and that MRI to supplement diagnosis of grade III condylar injury is warranted.

Sagittal wrist motion of carpal bones following intraarticular fractures of the distal radius.

Forty patients (mean age, 37 years) with intraarticular C2 and C3 Colles fractures were treated by open reduction, internal fixation and bone grafting. At a mean follow-up of 8 years radiocarpal and midcarpal motion was evaluated, the depth of the articular surface of the distal radius in the sagittal plane was measured and the presence of arthritis was noted. The fractures healed with a mean palmar tilt of 6 degrees , a mean ulnar tilt of 18 degrees and ulna variance within 1 mm of the contralateral side. The depth of the articular surface of the distal radius was 1.3 mm greater than the uninvolved side. Measurement of carpal bone angles relative to the radius in maximum flexion and extension revealed lunate extension of 23 degrees , lunate flexion of 15 degrees , capitate extension of 62 degrees , capitate flexion of 40 degrees . There was a significant correlation between articular surface depth and radiocarpal motion.

Diagnostic quality of dynamic high-resolution ultrasonography of the TMJ--a pilot study.

The aim of this study was to compare sensitivity, specificity, accuracy and positive and negative predictive value for high-resolution ultrasonography (HR-US) in diagnosing degenerative changes, effusion and disk displacement using magnetic resonance imaging (MRI) as a reference. Over a period of 6 months, 100 patients with TMJ disorders (200 TMJs) were investigated by an experienced radiologist with HR-US and magnetic resonance imaging (MRI). The MRI investigation showed degenerative changes in 190 joints (95%), while an effusion was found in 59 (29.5%) joints. At closed-mouth position a disc dislocation was found in 138 joints (69%) and in maximum-mouth-opening position disc dislocation was diagnosed in 76 joints (38%). In the determination of degenerative changes HR-US showed a sensitivity of 94%, a specificity of 100% and an accuracy of 94%. In the detection of effusion HR-US yielded a sensitivity of 81%, a specificity of 100% and an accuracy of 95%. In the determination of disk displacement at closed-mouth position HR-US showed a sensitivity, specificity and an accuracy of 92% each. At maximum-mouth-opening position HR-US reached a sensitivity of 86%, a specificity of 91% and an accuracy of 90%. The results of the current study imply that HR-US is a valuable diagnostic imaging method of the TMJ which can be used as an alternative method to a MRI-investigation, but is yet not able to replace it. Further studies have to be done to reduce false-negative results.

Cerebral vasculitis in a patient with hereditary complete C4 deficiency and systemic lupus erythematosus.

We describe the case of a female patient with hereditary complete C4 deficiency and systemic lupus erythematosus. She had suffered from lupus nephritis in early childhood. At the age of 23 years she developed severe lupus with skin disease and life-threatening cerebral vasculitis. Her cerebral disease was unresponsive to high-dose steroids, intravenous immunoglobulin, fresh frozen plasma and plasma exchange. Improvement was achieved with immunoadsorption in combination with mycophenolate mofetil. The patient made a complete recovery and is maintained in complete remission on mycophenolate and low-dose steroids.

Dorsal scapholunate ligament reconstruction using a periosteal flap of the iliac crest.

INTRODUCTION: To report a new technique for scapholunate ligament reconstruction, using a periosteal flap of the iliac crest. MATERIALS AND METHODS: In 12 patients with static SL instability, a periosteal flap was harvested from the anterior portion of the iliac crest. Following repositioning of the carpals, the flap was fixed to the scaphoid and lunate between an incompletely osteotomised scale at the dorsal horn of the scaphoid and lunate. Pin fixation of the scapholunate (SL) and CL interval secured postoperative reduction for 8 weeks. A forearm plaster cast was worn for 12 weeks. RESULTS: Eleven patients, all male, were available for follow-up at an average of 29 months. The interval between trauma and surgery averaged 15 months. The preoperative SL angle measured 77 deg, CL angle was -10 deg, and SL gap amounted to 5.2 mm. At follow-up, SL angle was 59 deg, CL angle measured -2 deg, and SL gap was 2.1 mm. SL gap, SL angle, and CL angle improved significantly from preoperative to follow-up values. According to the clinical grading system of Green and O'Brian, 6 patients scored in the excellent and good category and 5 in the fair category. Using the radiologic grading system of Gickel and Millender, 9 patients scored as excellent and good, whereas the 2 poor results were due to failure of the technique. CONCLUSION: The technique enables reduction of the SL angle and SL gap in patients with static reducible scapholunate instability. The initial results are quite encouraging.

Reliability and temporal variation of masseter muscle thickness measurements utilizing ultrasonography.

Muscle thickness may now be measured in the clinic by ultrasonography. The purpose of this study was to test (i) whether the position of the transducer on the muscle affects muscle thickness measurements and (ii) whether measurements from identical locations vary over time. Muscle thickness of one masseter muscle side was measured in each of 30 volunteers. Measurements were recorded at five different locations on the lateral surface of each muscle. Four measurement sessions were performed, and two sets of measurements were recorded at each session. Spatial position of the transducer had a clear effect on the muscle thickness measurements (P < 0.0001). Measurements made at the most upper and middle level were less and greater (P < 0.0001), respectively, than those made at the upper, lower, and most lower levels. Measurements from various positions did not differ (P > 0.05) when made at the same level. Masseter thickness measurements recorded at a given site were consistent across all of the testing sessions (P=0.575). The data suggest that reliable interpretation of longitudinal measurements of masseter thickness obtained with ultrasonography requires accurate repositioning of the transducer. Ultrasonography may be used to investigate the effect of specific treatment modalities on masseter thickness measurements.

Temporomandibular joint internal derangement: detection with 12.5 MHz ultrasonography.

The purpose of this study was to determine whether 12.5 MHz ultrasonography (US) could be used to assess the presence or absence of temporomandibular joint (TMJ) internal derangement (ID). In 48 consecutive patients with TMJ disorders 192 TMJ positions were investigated by US to analyse the functional disc-condyle relationship (DCR). In order to compare the respective findings with those of a diagnostic method offering a high accuracy, coronal and sagittal magnetic resonance imaging was carried out immediately afterwards. With US showing a sensitivity of 0.58 and 0.75, and a specificity of 0.92 and 0.84 for disc displacement with and without reduction, the data revealed US to be marginal in detecting the presence, but sensitive in detecting the absence of the respective types of a TMJ ID. In addition, with a positive predictive value of 0.83 and 0.71, and a negative predictive value of 0.81 and 0.87 for disc displacement with and without reduction, the results indicate that US may be insufficient in establishing a correct diagnosis for the presence or absence of the respective types of TMJ ID. Regarding the diagnosis of absence or presence of TMJ ID, the results demonstrate high-resolution (HR)-US to be sensitive in detecting the absence, and reliable in predicting the presence of TMJ ID. In view of the fact that the 12.5 MHz US technique proved to be a reliable diagnostic aid for the detection of normal, and the prediction of abnormal DCR, the results of this study should be of further interest and encourage research in its potential uses and diagnostic capabilities.

Temporomandibular joint osteoarthrosis diagnosed with high resolution ultrasonography versus magnetic resonance imaging: how reliable is high resolution ultrasonography?

The purpose of this study was to determine whether 12.5 MHz ultrasonography (US) could be used to assess the presence or absence of temporomandibular joint (TMJ) condylar osteoarthrosis. In 40 consecutive patients with TMJ disorders, 80 TMJs were investigated by US to analyse the condylar morphology. In order to compare the respective findings with those of a diagnostic method offering a high accuracy, coronal and sagittal magnetic resonance imaging was carried out immediately afterwards. With US showing a sensitivity of 87%, and a specificity of 20%, the data revealed US to be sensitive in detecting the presence, but insufficient in detecting the absence of osteoarthrosis. In addition, with a positive predictive value of 88%, and a negative predictive value of 18%, the results indicate that US may be valuable in diagnosing the presence, but insufficient in diagnosing the absence of osteoarthrosis. In view of the fact that the 12.5 MHz US technique proved to be a valuable diagnostic aid for the detection and prediction of abnormal condylar morphology, the results of this study should be of further interest and encourage research in its potential uses and diagnostic capabilities.

Risk factors for temporomandibular joint pain in patients with disc displacement without reduction - a magnetic resonance imaging study.

The purpose of this study was to evaluate whether the magnetic resonance (MR) imaging variables of temporomandibular joint (TMJ) internal derangement, osteoarthrosis and/or effusion may predict the presence of pain in patients with a clinical disorder of an internal derangement type (ID)-III. The relationship between TMJ ID-III pain and TMJ internal derangement, osteoarthrosis and effusion was analysed in MR images of 84 TMJs in 42 patients with a clinical unilateral diagnosis of TMJ ID-III pain. Criteria for including a TMJ ID-III pain patient were report of orofacial pain referred to the TMJ, with the presence of unilateral TMJ pain during palpation, function and/or unassisted or assisted mandibular opening. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ internal derangement, osteoarthrosis and effusion. Using chi-square analysis for pair-wise comparison, the data showed a significant relationship between the MR imaging findings of TMJ ID-III pain and those of internal derangement (P=0.01) and effusion (P=0.00). Of the MR imaging variables considered simultaneously in the multiple logistic regression analysis, osteoarthrosis (P=0.82) and effusion (P=0.08) dropped out as non-significant in the diagnostic TMJ pain group when compared with the TMJ non-pain group. The odds ratio that a TMJ with an internal derangement type of disk displacement without reduction might belong to the pain group was strong (2.7:1) and highly significant (P=0.00). Significant increases in risk of TMJ pain occurred with 'disk displacement without reduction in combination with osteoarthrosis' (5.2:1) (P=0.00) and/or 'disk displacement without reduction in combination with osteoarthrosis and effusion' (6.6:1) (P=0.00). The results suggest that TMJ pain is related to internal derangement, osteoarthrosis and effusion. However, the data re-emphasize the aspect that these MR imaging variables may not be regarded as the unique and dominant factors in defining TMJ pain instances.