Power Doppler ultrasonography assessment of entheses in spondyloarthropathies: response to therapy of entheseal abnormalities.

OBJECTIVE: To investigate the response to therapy of entheseal abnormalities assessed with power Doppler (PD) ultrasound (US) in spondyloarthropathies (SpA). METHODS: A total of 327 patients with active SpA who were starting anti-tumor necrosis factor (TNF) therapy were prospectively recruited at 35 Spanish centers. A PDUS examination of 14 peripheral entheses was performed by the same investigator in each center at baseline and at 6 months. The following elementary lesions were assessed at each enthesis (presence/absence): morphologic abnormalities (hypoechogenicity and/or thickening), entheseal calcific deposits, cortical abnormalities (bone erosion and/or proliferation), adjacent bursitis and intraenthesis and perienthesis (tendon body and/or bursa) PD signal. Response to therapy of each elementary lesion was assessed by calculating change in the cumulative presence from baseline to 6 months. Intraobserver reliability of PDUS was evaluated by blindly assessing the stored baseline images 3 months after the real-time examination. RESULTS: Complete data were obtained on 197 patients who received anti-TNF therapy for 6 months. In 91.4% of the patients there were gray-scale or PD elementary lesions at baseline and at 6 months. Cumulative entheseal morphologic abnormalities, intraenthesis PD, perienthesis PD, and bursitis showed a significant decrease from baseline to 6 months (p < 0.05). There was high intraobserver reliability for all elementary lesions (interclass correlation coefficient > 0.90, p < 0.0005). CONCLUSION: Entheseal morphologic abnormalities, PD signal, and bursitis were US abnormalities that were responsive to anti-TNF therapy in SpA. PDUS can be a reproducible method for multicenter monitoring of therapeutic response in enthesitis of SpA.

Estudio comparativo mediante tomografía computarizada de la morfología de la sutura timpanoescamosa entre colesteatoma atical y oídos sanos / Comparative study through TC of the tympanosquamous suture in cases of attical cholesteatoma vs healthy ears

Introducción y objetivos: Habíamos observado, al intervenir oídos con colesteatoma, una mayor procidencia del extremo anterior de la sutura timpanoescamosa (STE). Queríamos averiguar si estos hallazgos correspondían a una especial morfología de la STE en los colesteatomas. Material y métodos: Realizamos un estudio retrospectivo, mediante tomografía computarizada (TC) preoperatoria, de la STE de pacientes intervenidos por colesteatoma entre enero de 2006 y diciembre de 2008. Se incluyó a pacientes mayores de 18 años, no intervenidos anteriormente, con TC realizada en el propio hospital e histología demostrativa de colesteatoma (n=31). Comparamos los hallazgos de la STE de estos 31 casos con los de 30 oídos sanos. El grupo sano incluyó 20 casos con colesteatoma unilateral (20 sanos/31 colesteatomas) y un grupo sano control estudiado con motivo de implante coclear (n=10). Se realizaron mediciones de la distancia en mm considerando dos puntos A y B de la STE (A era el más distal y B, el más proximal al extremo de la sutura). Seleccionamos los cortes de TC correspondientes a la máxima y la mínima separación de la STE. Resultados: Comparando las distancias máxima y mínima de la STE en los puntos A y B de todos los oídos, según estado patológico (sanos frente a colesteatoma), detectamos una menor distancia mínima A (p=0,036) y mínima B (p=0,014) en los oídos sanos respecto a los patológicos; no encontramos diferencias estadísticamente significativas de las distancias máximas A y B (p>0,05). Conclusiones: Este estudio aporta datos objetivos sobre un menor cierre de la STE en los casos de colesteatoma frente a oídos sanos. Relacionamos este hallazgo con la etiopatogenia del colesteatoma atical (AU)

Introduction and objectives: When performing surgery on ears with cholesteatoma we observed a higher prominence of the anterior edge of the tympanosquamous suture (TSS). The aim was to find out whether these surgical findings corresponded to a particular morphology of the tympanosquamous suture (TSS) in cholesteatomas. Material and methods: A retrospective analysis was carried out using preoperative computed tomography (CT) of the TSS in patients undergoing surgery for cholesteatoma in the period between January 2006 and December 2008. Patients older than 18 years were included, who had not been previously operated, with a CT performed at the hospital and with a histology which proved cholesteatoma (n=31). The findings of the TSS from these 31 cases were compared with those of 30 healthy ears. The healthy group included 20 cases of unilateral cholesteatoma (20 healthy/31 cholesteatomas) and a control group of 10 healthy patients studied for cochlear implants (n=10). Measurements of the distance in mm. were made selecting two points A and B of the TSS (A being the furthest point and B the nearest to the edge of the suture). The CT cuts were selected according to the greatest and smallest separation of the TSS. Results: Comparing the maximum and minimum distance of the TSS in points A and B of all the ears, according to pathological state (heathly ears vs cholesteatoma ears), we detected a reduced minimal distance in A (p=0.036) and B (p=0.014) in the healthy ears with respect to the cholesteatoma ears. No statistically significant differences were found in maximum distances A and B (p>0.05). Conclusions: This study provides objective data on a lesser closure of the TSS in cases of cholesteatoma vs healthy ears. We correlate this finding with the aetiopathogenesis of attical cholesteatoma (AU)

Comparative study through TC of the tympanosquamous suture in cases of attical cholesteatoma vs healthy ears.

INTRODUCTION AND OBJECTIVES: When performing surgery on ears with cholesteatoma we observed a higher prominence of the anterior edge of the tympanosquamous suture (TSS). The aim was to find out whether these surgical findings corresponded to a particular morphology of the tympanosquamous suture (TSS) in cholesteatomas. MATERIAL AND METHODS: A retrospective analysis was carried out using preoperative computed tomography (CT) of the TSS in patients undergoing surgery for cholesteatoma in the period between January 2006 and December 2008. Patients older than 18 years were included, who had not been previously operated, with a CT performed at the hospital and with a histology which proved cholesteatoma (n=31). The findings of the TSS from these 31 cases were compared with those of 30 healthy ears. The healthy group included 20 cases of unilateral cholesteatoma (20 healthy/31 cholesteatomas) and a control group of 10 healthy patients studied for cochlear implants (n=10). Measurements of the distance in mm. were made selecting two points A and B of the TSS (A being the furthest point and B the nearest to the edge of the suture). The CT cuts were selected according to the greatest and smallest separation of the TSS. RESULTS: Comparing the maximum and minimum distance of the TSS in points A and B of all the ears, according to pathological state (heathly ears vs cholesteatoma ears), we detected a reduced minimal distance in A (p=0.036) and B (p=0.014) in the healthy ears with respect to the cholesteatoma ears. No statistically significant differences were found in maximum distances A and B (p>0.05). CONCLUSIONS: This study provides objective data on a lesser closure of the TSS in cases of cholesteatoma vs healthy ears. We correlate this finding with the aetiopathogenesis of attic cholesteatoma.

Validity, reproducibility, and responsiveness of a twelve-joint simplified power doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis.

OBJECTIVE: To investigate the validity, reproducibility, and responsiveness of a simplified power Doppler ultrasound (PDUS) assessment of joint inflammation compared with a comprehensive 44-joint PDUS assessment in patients with rheumatoid arthritis (RA) who started therapy with a biologic agent. METHODS: A total of 160 patients with active RA who started a biologic agent were prospectively recruited in 18 Spanish centers. The patients underwent clinical and laboratory assessment and blinded PDUS examination at baseline and 6 months. A PDUS examination of 128 synovial sites in 44 joints was performed. US synovitis and PD signal were semiquantitatively graded from 1 to 3 in all synovial sites. US count and index for synovitis and PD signal were obtained. PDUS intraobserver and interobserver reliability were evaluated. A process of data reduction based on the frequency of involvement of synovial sites by both synovitis and PD signal was conducted. Construct and discriminant validity of a simplified PDUS assessment was investigated. RESULTS: A PDUS simplified assessment including 24 synovial sites from 12 joints detected 100% of patients with synovitis and 91% of patients with PD signal. There was a highly significant correlation between the 44-joint count and index for synovitis and PD signal and the 12-joint count and index for synovitis and PD signal at baseline and 6 months (r = 0.84-0.90, P < 0.0005). The smallest detectable difference was lower than the mean change in simplified PDUS variables. CONCLUSION: A 12-joint PDUS assessment of RA joint inflammation may be a valid, feasible method for multicenter monitoring of therapeutic response to biologic agents.