Influence of methotrexate on radiographic progression in rheumatoid arthritis: a sixty-month prospective study.

OBJECTIVE: To evaluate if methotrexate (MTX) can slow disease progression, as determined radiographically, in comparison to other disease modifying drugs in rheumatoid arthritis (RA) patients. MATERIALS AND METHODS: Pairs of hand and wrist radiographs from 30 patients treated with MTX and 30 treated with D-penicillamine (DP) were evaluated blindly and separately by two radiologists (A and B) using reference radiographs for scoring. A scale scoring similar to Larsen's standard radiographs with minor modifications was used. The radiographs studied were obtained at the beginning and 5 years after therapy in both groups. RESULTS: A significantly greater worsening was found in the DP-treated patients (p = 0.025), as compared to MTX patients. Methotrexate showed a slower rate of disease progression than DP. Furthermore, in the MTX group 15 patients remained radiographically stable, 9 worsened and 6 were healed. In contrast, in the DP group 22 patients remained radiographically stable, 8 worsened and none improved. CONCLUSIONS: The rate of radiographic progression in RA patients was lower in MTX-treated patients compared to those treated with DP. Six patients showed radiological improvement after MTX treatment. Therefore, it seems that MTX could be considered a disease modifying drug.

Neglected congenital dislocation of the hip. Role of computed tomography and computer-aided design for total hip arthroplasty.

Computed tomography (CT) provides important three-dimensional anatomic details in congenital dislocation of the hip that are useful for total hip arthroplasty (THR) and are not obtainable with conventional radiographic evaluation. In this study, 84 patients (119 hips) with congenital dislocation of the hip were evaluated with CT before surgery. Specifically, both the acetabulum and the femur were analyzed to make the best selection of the prosthesis. The average anteversion of the acetabulum was 23 degrees, with an opening of 30.9 mm and a depth of 14.7 mm. The bone stock of the true acetabulum was calculated and the average available diameter for the acetabular implant was 44.9 mm. The CT topogram revealed the true leg-length discrepancy (average 0.5-1.9 cm), and the amount of a shortening osteotomy when necessary was determined. Finally, to determine the stem with optimum fit and fill, a three-dimensional reconstruction of the femoral canal using CT data and computer-aided design (CAD) was matched with a three-dimensional geometry of several stem designs and sizes obtained from a CAD system.

Water as contrast medium for computed tomography study of colonic wall lesions.

A tap water enema combined with intravenous iodine contrast medium was used for computed tomographic (CT) study of the entire clean colon in 35 patients. Thirty of them showed a high suspicion of rectal, colon, or cecal pathology at either clinical examination, barium enema study, or endoscopy. The remaining five patients were examined for suspected local recurrence of carcinoma. This CT technique detected the wall abnormality in all but one case with two small adenomatous polyps. This procedure, which is simple, inexpensive, and has a good acceptance and tolerance, can accurately detect mural wall abnormalities.

Omental herniation through the foramen of Morgagni. Diagnosis with chest computed tomography.

The fat accumulation most frequently seen in the peridiaphragmatic areas represents herniations of abdominal fat or epicardial fat pad. We present a patient with a large fatty mass after 10 months of corticosteroid therapy in which computed tomography demonstrated omental vessels, thus proving that it was omental herniation through Morgagni's foramen.

Use of water or air as oral contrast media for computed tomographic study of the gastric wall: comparison of the two techniques.

Thirty-four patients with a high suspicion of gastric lesion at endoscopy were studied by two computed tomographic (CT) techniques: one using a gas-producing agent and the other using water as an oral contrast media. Intravenous contrast medium was also given in all patients who underwent the water technique. Final histologic proof was obtained either by endoscopy or at surgery. Both CT techniques detected the wall abnormality in 32 of the 34 patients, and both techniques missed the same lesion in two patients. The water technique showed more gastric wall details and the lesion's limits could be defined more accurately. The acceptance and tolerance of the gas-producing agent was better in severely ill patients than tap water.