Radiographic Presentation Research Articles

Histological Diversity, Diagnostic Challenges, and Surgical Treatment Strategies of Fibrous Dysplasia of Upper and Mid-Thirds of the Craniomaxillofacial Complex.

Background:Owing to the overlapping clinical, radiographic and histopathological features among the diverse group of Fibro-osseous lesions, a precise and definitive diagnosis of Fibrous Dysplasia (FD) can be quite challenging. Moreover, FD itself may manifest with widely varying clinical presentations, radiographic appearances and histological pictures, depending upon the maturity of the lesion, and the relative quantum of its ‘fibrous’ and ‘osseous components’. Prompt and accurate diagnosis of Fibrous Dysplasia (FD) of the Craniomaxillofacial region is particularly important, as the condition is capable of causing considerable facial asymmetry or deformity leading even to marked disfigurement, which can have a profound psychosocial impact on the patient. Involvement of Maxillofacial bones by aggressive forms of FD, can produce serious functional debility as well, by compromising airway, breathing, vision, hearing, occlusion, mastication and mouth opening. Calvarial bone involvement can produce cranial asymmetry, and cranial base involvement can lead to persistent headaches, facial pain, numbness, and other neurological deficits owing to compression of cranial nerves.Aims and Objectives:To evaluate the importance of early and precise diagnosis, with prompt surgical management of these lesions, for a successful overall esthetic and functional outcome.Materials and Methods:A Case series of 15 patients, showcasing the principal variants of FD affecting the Craniomaxillofacial complex, namely, the Monostotic and Craniofacial forms have been described. Diversity in their Clinical, Radiographic and Histopathological presentations; their management modalities elucidating the various surgical approaches employed to access and excise these bone pathologies, have been provided along with a review of existing literature.Results:Various surgical approaches may be employed to access the lesions, depending upon their location, extent and involvement. Treatment protocols range from complete surgical excision to surgical shaving and recontouring, and must be decided upon on a case to case basis, with the aim to achieve the best possible esthetic and functional outcome with the least postoperative morbidity.Conclusion:Correlation of HPE with history, clinical features, biological behaviour, radiographic and CT appearance, laboratory findings, and intra-operative findings is imperative, so that they can be distinguished from other bony lesions and an appropriate, ideal and effective treatment modality can be instituted in time, so as to achieve the most favourable esthetic and functional outcome.

Impact of Diabetes Mellitus on the Presentation and Response to Treatment of Adults With Pulmonary Tuberculosis in Qatar.

BackgroundPersons with diabetes mellitus (DM) have a 3-fold increased risk of tuberculosis (TB). Atypical radiographic findings and differences in bacteriologic response during anti-TB treatment have been reported in earlier studies; however, the findings have varied. We evaluated the effect of DM on manifestations and response to treatment in adults with pulmonary TB in Qatar.MethodsThe impact of DM on the clinical and radiographic presentations of pulmonary TB and bacteriologic response during anti-TB treatment was evaluated between January 2007 and December 2011, comparing patients with and without DM. This is a retrospective unmatched case-control study conducted at a large national hospital. Cases and controls were randomly selected from patients diagnosed with pulmonary TB over a 5-year period. Sputum culture conversion was assessed after 2 months of anti-TB treatment.ResultsClinical symptoms were similar between patients with and without DM. Patients with DM had a higher initial sputum acid-fast bacillus (AFB) smear grade and were less likely to have cavitary lesions on initial chest radiographs than patients without DM. Of 134 adults with DM and TB, 71 (53%) remained sputum culture positive after 2 months of anti-TB treatment, compared with 36 (27%) patients without DM.ConclusionsDM was associated with atypical radiographic findings and delayed sputum culture conversion at 2 months in adults with pulmonary TB in Qatar. Increased health education of patients with DM about symptoms of TB, low thresholds for evaluation for active TB, and close monitoring of bacteriologic response to treatment among patients with TB and DM are warranted.

Managements of giant cell tumor within the distal radius: A retrospective study of 58 cases from a single center

BackgroundGiant cell tumor of bone (GCTB) in distal radius is a benign but invasive bone tumor characterized by strong aggressive behavior and frequent recurrence. MethodsTo identify recurrence related risk factors and decide suitable surgical strategy, the potential tumor- and treatment-specific factors, post-operative oncologic and functional outcomes were collected and analyzed from 58 patients with GCTB of the distal radius at our center. ResultsWith the numbers available, our analysis strongly indicated soft tissue extension (with vs. without, HR: 5.645, 95% CI: 1.424 to 22.377, p = 0.014) and size of GCTB (diameter ≥ 5 cm vs. 5 cm HR: 3.893, 95% CI: 1.109 to 13.659, p = 0.034) are the two independent risk factors related to local relapse. Neither surgical procedures (curettage vs. en-bloc resection) nor other factors apparently affected the recurrence, including age, tumor nature, dominant hand involvement, pathological fracture conditions or pre-operative denosumab. However, intralesional curettage group achieved much better functional scores ((VAS: 2.5 ± 0.8 vs. 3.6 ± 1.2, p = 0.011; MSTS: 20.2 ± 3.4 vs. 16.7 ± 3.8, P = 0.034; DASH 9.1 ± 3.9 vs. 16.4 ± 5.5, p = 0.030) and much less complications (non-unions, dislocations, fractures and infections) compared to resection ones. Furthermore, denosumab provided dramatic pain reduction and strong tumor suppression, facilitating curettage with local adjuvants even in GCTB with advanced status. ConclusionsTaken together, the radiographic presentations (soft-tissue extension and tumor size) are the strong prognostic predictors of local recurrence of GCTB in distal radius. In most tumors, an initial treatment with curettage remains feasible and first-choice, especially with the adjuvant denosumab.

782. Risk Factors, Clinical Characteristic, and Treatment Outcomes for Nontuberculous Mycobacterial Disease in Mexico

BackgroundNontuberculous Mycobacteria (NTM) cause diverse clinical manifestations in multiples clinical setting, and in the past years, there has been an increasing prevalence and variability among geographic regions, this associated with a diversity of hosts and clinical manifestations. We objective was evaluated the clinical and microbiologic characteristic, and the treatment outcomes related to slowly growing mycobacteria (SGM) and rapidly growing mycobacteria (RGM).MethodsWhen conducting a retrospective study between January 2001 and December 2017, retrospectively their medical records were reviewed for obtainments of site of isolation or infection, comorbidities or predisponent condition, clinical and radiographic presentation, and treatment outcomes.ResultsA total of 90 patients with isolated of RGM and 87 within SGM were evaluated among these M. avium and M. fortuitum were the most predominant species. HIV infection was the predominat risk factor for SGM infections (P < 0.001); the conditions associated to RGM infections were cancer (P = 0.02787); diabetes mellitus (DM) (P = 0.01418), chronic kidney disease (CKD)(P = 0.04662), use of immunosuppressive medication (P < 0.001), and use of invasive device only were present in the RGM group. In the RGM group, lung infection was the most common site of infection (43%); in the SGM group, the disseminated disease was the most common (54%). The time of treatment was more prolonged in the SGM group (196 vs. 229 days, P = 0.0309). In the RGM group, the rate of cure was higher in the subgroup of Mycobacterial stream infections and disseminated disease (15 vs. 5, P = 0.0146). In the analysis of lung infection who meet the IDSA/ATS criteria were divided into the group with treatment and the group without treatment, the outcomes were not significative in both groups.ConclusionThe NTM infections are an important cause of disease in patients with chronic conditions such as cancer, immunosuppressive medication, CKD, use of invasive device, and DM. HIV infection persist as the first risk factor for M. avium disseminated disease, the treatment for this latter condition in spite of more prolonged, it had a lower rate of cure. The treatment of lung infections for NTM must be individualized although the IDSA/ATS criteria are met.Disclosures All authors: No reported disclosures.

Endoscopic Management of Postbariatric Fistulae and Leaks

The number of bariatric procedures performed annually is increasing along with the number of complications. Gastrointestinal leak after bariatric surgery generally portends high morbidity and mortality, and its management depends on clinical and radiographic presentation. A leak is defined as an enteric defect with extravasation of luminal contents. Fistulae are abnormal connections between two epithelialized surfaces, are usually chronic, and may develop from long-standing leaks. Endoscopic therapies may offer an attenuated risk profile compared with surgical intervention and play a growing role in the management of postbariatric complications. Leak resolution may require multiple endoscopic sessions and modalities (e.g., stents, adhesives, plugs, clips, suturing, and VAC-assisted closure); therefore, it is critical to have appropriate follow-up and surveillance after therapeutic endoscopic intervention. This review discusses endoscopic leak and fistula management through endoscopic procedures, addressing indications and candidates for procedure, contraindications, recipient evaluation, and aspects of procedure, including proper timing, equipment, and types. Figures show Roux-en-Y gastric bypass, sleeve gastrectomy, management options for leaks after bariatric surgery, a diagnostic algorithm for leaks, upper gastrointestinal series performed with Gastrografin, and computed tomographic scans that demonstrate extraluminal air extending along the diaphragmatic surface of the spleen and a perisplenic gas and fluid-filled collection on the lateral margin. Tables list complications that follow bariatric surgery; an excerpt from the 2008 American Society for Gastrointestinal Endoscopy Guidelines; recommended equipment for endoscopic defect management; classification system based on duration after bariatric surgery; classification and approach to management based on clinical presentation and radiographic findings; summary of recommendations for pre-endoscopy, index endoscopy, therapeutic endoscopy, and posttherapeutic endoscopy; and early and late complications of stent placement. This review contains 7 highly rendered figures, 7 tables, and 104 references.

Use of hyperbaric oxygen therapy in pediatric neuro-oncology: a single institutional experience.

Hyperbaric oxygen therapy (HBOT) has been utilized as adjunctive treatment of CNS tumors and for radiation necrosis (RN) with reported success. The safety and efficacy in pediatric patients is less understood. Seven patients (ages 10-23 years, six females) were treated with HBOT (3-60 sessions) for either RN (n = 5) or tumor-associated edema (n = 2). Tumor diagnosis included low-grade glioma (n = 4, two with neurofibromatosis type 1), meningioma (n = 1), medulloblastoma (n = 1) and secondary high grade glioma (n = 1). Prior therapies included: surgery (n = 4), chemotherapy (n = 4) and radiation (N = 5: four focal, one craniospinal). Three underwent biopsy: one confirming RN, one high-grade glioma, and one low-grade glioma. Patients were assessed for clinical and radiographic changes post HBOT. Median time to clinical and radiographic presentation was 8.5months (range 6 months-11years) in those who had prior radiation. Clinical improvement after HBOT (median: 40 sessions) was observed in four of seven patients. Symptoms were stable in two and worsened in one patient. Radiographic improvement was seen in four patients; three had radiographic disease progression. In the subgroup treated for presumed and biopsy-confirmed RN (n = 5), four of five (80%) had clinical and radiographic improvement. There were no long-term adverse events due to HBOT. HBOT is safe and well-tolerated in pediatric and young adult patients with CNS tumors. Clinical and radiographic improvements were observed in over half of patients. Clinical trials are needed to establish safety and efficacy of HBOT as adjunct therapy in pediatric CNS tumors.

Actinomycosis in Cancer Patients

Introduction Actinomycosis is a condition characterized by chronic granulomatous infection, frequently with the formation of abscesses, tissue fibrosis, and draining sinuses. The most common presentation in the immunocompetent host is a cervicofacial form. However, this disease can affect any body site. Very little is known about actinomycosis features in immunocompromised patients. Materials and Methods We performed a retrospective chart review of 65 patients from an academic cancer hospital who had positive diagnostic testing for Actinomyces species. Of those 65 patients, 46 were ultimately diagnosed with frank actinomycosis and the remaining 19 patients were considered colonized. We reviewed patient characteristics, clinical and radiographic presentations, and response to antibiotic therapy. Results Pulmonary actinomycosis was the most common clinical presentation and, based on the radiological presentation, malignancy was often included in the differential diagnosis. A majority of the patients included in this report had a positive clinical response to prolonged antibiotic therapy. Discussion As expected, distinguishing clinically significant disease from colonization proves quite complex. As stated previously, 19 patients of 65 were thought to have colonization or contamination of the sample. The factors influencing clinicians to make the decision not to treat were not always clear in these cases. In some, the presence of abnormal imaging findings without symptoms appears to have been a major determinant in the decision to consider a positive culture as contamination instead of infection. Until more definitive criteria are delineated in the literature, diagnosis and treatment of actinomycosis rely on a combination of clinical and radiographic findings.

The Art and Science of Diagnosing Mycoplasma pneumoniae Infection.

Mycoplasma pneumoniae causes a significant burden of disease in children as both upper and lower respiratory tract infections (URTIs and LRTIs). A positive pharyngeal polymerase chain reaction (PCR) or serology for M. pneumoniae can be found in 4–39% of children hospitalized with community-acquired

The 100 top-cited publications in psoriatic arthritis: a bibliometric analysis.

Citation analysis is a quantitative, bibliometric method that analyzes the frequency and pattern of citations in any given scientific discipline. Over the last two decades, the study of psoriatic arthritis has undergone substantial progress, which has enhanced our ability to assess and treat the disease, and yet an updated citation analysis that reflects these advances is lacking. To highlight the scientific progress in psoriatic arthritis by identifying and analyzing the 100 top-cited psoriatic arthritis articles from the last 40years. Publications on psoriatic arthritis were identified using the Scopus citation database and Web of Science. No date range limits were applied. Data on the 100 top-cited publications were extracted and analyzed. Of the 100 top-cited publications, the median number of citations per publication was 265.9. Articles originated from 29 different countries. Publication dates ranged from 1973 to 2014. The majority (n=88) were published after 1994, and the greatest number of highly cited psoriatic arthritis publications were reported between 2001 and 2007 (n=36). Journals with the highest number of top-cited articles included Arthritis and Rheumatology (formerly Arthritis and Rheumatism) (n=26), followed by Annals of Rheumatic Diseases (n=21) and Journal of Rheumatology (n=11). The top six journals with the most highly cited psoriatic arthritis articles were rheumatology journals, with the exception of the Journal of American Academy of Dermatology, a dermatology-based periodical. General medical journals published only nine of the 100 top citations. Impact factors ranged from 2.133 to 44.002, with a mean impact factor of 9.103. There were five authors with 10 or more highly cited psoriatic arthritis publications and 30 authors with five or more of the top publications. Subgroup analysis of the top 25 articles included nine randomized clinical trials, nine observational studies, five reviews, and two guideline statements. Additional subgroup analysis identified the top five hallmark trials in the field. Key publications provided data on classification criteria, disease prevalence, patterns of clinical and radiographic presentation, disease outcomes, associated cardiovascular disease risk, immunologic features and HLA associations, and efficacy and therapeutic benefit of TNFα inihbitors, interleukin-12/23 antagonists, and sulfasalazine. The study of psoriatic arthritis is rapidly evolving. This bibliometric analysis delineates the landmark publications in psoriatic arthritis that have defined innovative therapeutic modalities and provided critical reviews, guidelines, and other key studies, which highlight the important progress made in the field.

PULMONARY CRYPTOCOCCOSIS MASQUERADING AS LYMPHOMA

SESSION TITLE: Pulmonary SESSION TYPE: Global Case Reports PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM INTRODUCTION: Pulmonary cryptococcosis (PC) is an uncommonly diagnosed disorder. We describe a unique case of PC presenting as lymphadenopathy, diagnosed by endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) technique. CASE PRESENTATION: 58-year-old, never smoker, male with follicular lymphoma (status post completion of 6 cycles of R-CHOP (Rituximab, Cyclophosphamide, Vincristine, Doxorubicin)) was referred to for evaluation of new positron emission tomography/computed tomography (PET/CT) avid right hilar adenopathy, and left upper lobe nodular opacity. His review of systems was positive for mild shortness of breath on exertion; and an unremarkable physical exam. Laboratory studies were significant for lactate dehydrogenase level of 283, and no preceding neutropenia or lymphopenia. Significant interval history included hemophillus influenza pneumoni Patient underwent a EBUS-TBNA of the right hilar lymph node. Cytology was negative for malignant cells but showed intracellular yeast in histiocytes; the tissue culture was positive for Cryptococcus neoformans. Patient was started on fluconazole and CT of the chest done 2 months after treatment initiation, showed no evidence of hilar lymphadenopathy. DISCUSSION: PC is an uncommonly diagnosed disorder and seen in less than 4% of patients diagnosed with cryptococcosis. Common predisposing factors include AIDS, chronic corticosteroid use, and solid organ-transplants. Most common radiographic presentation is single or multiple, small, peripherally distributed, upper and middle lung zone predominant, pulmonary nodules and bilateral airspace consolidation. In studies by Li-Xuan et al and Chang et al, radiographic presentation of PC was compared amongst immunocompromised and immunocompetent host, pulmonary nodules were the most common finding and associated cavitation were more frequently seen in immunocompromised patients. In a study done by Lacomis et al, patients with HIV, solid organ transplant and non-HIV, non-solid organ transplants were looked at; lymph node enlargement was uncommon in all the groups but more commonly found in the HIV group and was always less than 1.5cm. SCrAg is positive in 71% of patients with disseminated disease; however only positive in 21% of patients with pulmonary disease alone. Cultures grown from biologic samples is the Gold standard test for diagnosis of cryptococosis9. In 2016, Schmalzle et al11, looked at 583 patients with malignancy with culture results positive for cryptococcus and found that 83% of patients had hematologic malignancy. Pulmonary disease was also more commonly seen in patients with hematologic malignancies and in these case cryptococcal antigen was negative in majority of the patients. CONCLUSIONS: Cryptococcal lymphadenitis should be considered in the differential diagnosis in an immunocompromised patient presenting with lymphadenopathy despite a negative serum cryptococcal antigen. Reference #1: Chang, Wei-Chou et al. “Pulmonary Cryptococcosis.” CHEST , Volume 129 , Issue 2 , 333 – 340. Reference #2: Chichra A, Lama KW, Koenig SJ. Respiratory failure with hilar mass: Role of endobronchial ultrasound-guided transbronchial needle aspiration in the medical intensive care unit. Lung India : Official Organ of Indian Chest Society. 2015;32(2):178-181. Reference #3: Li-Xuan, Xie. “Pulmonary Cryptococcosis: Comparison of Clinical and Radiographic Characteristics in Immunocompetent and Immunocompromised Patients.” Chest, Elsevier, 23 Dec. 2015. DISCLOSURES: No relevant relationships by Robert Lee, source=Web Response No relevant relationships by Priyanka Makkar, source=Web Response No relevant relationships by Carlie Sigel, source=Web Response No relevant relationships by Jonathan Vaucher, source=Web Response

MS19.01 Drug-Induced Pneumonitis with IO: How worried should we be for our Lung Cancer Patients

MS19.01 Drug-Induced Pneumonitis with IO: How worried should we be for our Lung Cancer Patients

Morel-Lavallée Lesions

The Morel-Lavallee (ML) lesion is a traumatic, closed soft tissue degloving injury. They have an inconsistent presentation, and diagnosis is often delayed. This review describes the pathophysiology of this injury, emphasizes the clinical and radiographic presentation, and highlights current management strategies. Early studies reported ML lesions occur solely over the greater trochanter, and while this remains the most common site, ML lesions can occur throughout the body. Early operative debridement should be performed, as aspiration or observation has an unacceptably high failure rate. Sclerodesis is an option in chronic ML lesions. ML wounds can be closed unless active infection is present. ML lesions are more frequently being recognized incidentally on imaging but are still under-diagnosed in trauma patients. The delay in diagnosis and unfamiliarity with treatment options can lead to poor outcomes and unnecessary complications.

Role of pre-stroke immunity in ischemic stroke mechanism among patients with HIV

ABSTRACTIndividuals with HIV are at a higher risk of stroke compared to uninfected populations. The role of HIV-related immunosuppression in stroke mechanism is uncertain. Our aim is to test the hypothesis that stroke mechanisms among HIV+ individuals vary according to preceding CD4 counts. We carried out a retrospective chart review of inpatient admissions for ICD-9 defined ischemic events (TIA or stroke) in HIV+ individuals from 2002 to 2016 at a tertiary care center. Stroke mechanisms were ascertained based on radiographic and clinical presentation, and adjudicated by the treating team and confirmed separately by a vascular neurologist. Vascular risk factors, use of antiretroviral drugs (ARVs), nadir CD4 and current CD4 counts (cells/mm3) were captured to build logistic regressions and generalized linear models to calculate the odds ratios (OR) and beta estimates with their respective 95% confidence intervals. We found that among 115 cases (median age 52, 64% men), stroke mechanisms were 22% due to large artery atherosclerosis (LAA), 17% small artery disease, 16% infectious, 8% cardioembolic, 21% cryptogenic, and 16% other etiologies. The median nadir CD4-count was 153 (IQR 22–274), and 312 (IQR 88–518) at the time of stroke, and 53% were on ARVs. LAA was more common with longer HIV infection (OR 1.1 per year, 1.0–1.2) and nadir CD4 counts <200 (OR 6.7, 1.4–31.9). Stroke due to LAA was associated with higher CD4 count the year prior to stroke (B = 0.009, P = 0.06 for the interaction) independent of CD4 nadir <200 (B = 1.88, P = 0.035). We concluded that in this sample, LAA was the most frequent stroke mechanism among HIV+ individuals with nadir CD4 < 200 but higher CD4 counts near the time of stroke. Determining the association between pre-stroke immune status and stroke mechanisms may allow a targeted approach to stroke prevention.

An overview of meningiomas.

Meningiomas are the most common primary intracranial tumor. Important advances are occurring in meningioma research. These are expected to accelerate, potentially leading to impactful changes on the management of meningiomas in the near and medium term. This review will cover the histo- and molecular pathology of meningiomas, including recent 2016 updates to the WHO classification of CNS tumors. We will discuss clinical and radiographic presentation and therapeutic management. Surgery and radiotherapy, the two longstanding primary therapeutic modalities, will be discussed at length. In addition, data from prior and ongoing investigations of other treatment modalities, including systemic and targeted therapies, will be covered. This review will quickly update the reader on the contemporary management and future directions in meningiomas. [Formula: see text].

Diffuse Parenchymal Lung Diseases in the Elderly

Diffuse parenchymal lung diseases comprise a heterogeneous group of disorders with varying clinical, physiologic, radiographic and pathologic presentations. Age of onset varies considerably. Interstitial lung abnormalities, and in particular, idiopathic pulmonary fibrosis (IPF), occur much more commonly in older persons. In recent years, advances have been made in understanding IPF pathogenesis and changes have occurred in relation to how IPF is managed. The cause of IPF remains unclear. It is thought that a non-specific injury in susceptible individuals triggers a progressive fibrotic response. Genetic susceptibility is increasingly recognised. Multidisciplinary team input is essential for making a diagnosis. Although, originally thought to be an inflammatory process, it has been shown that anti-inflammatory therapies may, in fact, be harmful to the patient. Two anti-fibrotic therapies (pirfenidone and nintedanib) are now available. There is a better recognition of prognosis and improved symptom control and management of end of life issues. As life expectancy increases, further studies are necessary to assess the impact and natural history of interstitial lung diseases in the elderly.

Clinical and radiographic presentation and treatment of patients with cervical deformity secondary to thoracolumbar proximal junctional kyphosis are distinct despite achieving similar outcomes: Analysis of 123 prospective CD cases

CD development secondary to PJK was recently documented in adult spinal deformity patients after surgical correction for thoracolumbar ASD. This study analyzes surgical management of patients with CD secondary to proximal junctional kyphosis (PJK) versus patients with primary CD. Retrospective review of multicenter cervical deformity (CD) database. CD defined as at least one of the following: C2–C7 coronal Cobb > 10°, cervical lordosis (CL) > 10°, cervical sagittal vertical axis (cSVA) > 4cm, CBVA > 25°. Patients were grouped into those with PJK (UIV +2 < −10°) prior to cervical surgery versus who don’t (Non-PJK). Independent t-tests and chi-squared tests compared radiographic, clinical, and surgical metrics between PJK and non-PJK groups. Of 123 eligible CD patients, 26(21.1%) had radiographic PJK prior to cervical surgery. PJK patients had significantly greater T2–T12 thoracic kyphosis (−58.8° vs −45.0°, p = 0.002), cSVA (49.1 mm vs 38.9 mm, p = 0.020), T1 Slope (42.6° vs 28.4°, p < 0.001), TS-CL (44.1° vs 35.6°, p = 0.048), C2-T3 SVA (98.8 mm vs 75.8 mm, p = 0.015), C2 Slope (45.4° vs 36.0°, p = 0.043), and CTPA (6.4° vs 4.6°, p = 0.005). Comparing their surgeries, the PJK group had significantly more levels fused (10.7 vs 7.4, p = 0.01). There was significantly greater blood loss in PJK patients (1158 ± 1063vs 738 ± 793 cc, p = 0.028); operative time, surgical approach, and BMP-2 use were similar (all p > 0.05). PJK patients experienced higher rates of complications 30 and 90 days post-operatively (23.1% vs. 5.2%, p = 0.004; 30.8% vs. 19.6%, p = 0.026), and more instrumentation failure 30 days postoperatively (7.8% vs. 1.0%, p = 0.004). Patients with cervical deformity secondary to PJK had worse baseline CD, despite no differences in HRQL or demographics. Surgical correction of CD associated with PJK required more invasive surgery and had higher complication rates than non-PJK patients, despite achieving similar clinical outcomes.

Flapless boning to increase space by piezosurgery: A novel mini-invasive strategy for teeth extraction. A retrospective study.

This study aimed to investigate the application of piezosurgery-associated flapless surgery for increasing bone space during teeth extraction and evaluate its success rate, postoperative outcomes, and incidence of major complications.From January 2014 to December 2016, patients who experienced teeth extraction via piezosurgery-associated flapless surgery were enrolled in this study. The positions, diagnosis, dental medical history, and radiographic examination of teeth were recorded before the treatment. During the surgery, the fracture or displacement of root, injuries of soft tissue, and fractures of the alveolar process were noted.A total of 140 patients fulfilled the eligibility criteria in the present study. All these teeth were classified into 4 groups based on diagnosis: residual roots that underwent root canal therapy (28 cases), teeth with root fracture (37 cases), teeth extraction because of orthodontics needed (31 cases), and the vertically impacted lower third molar (44 cases). The radiographic presentation revealed about 50% ankylosed teeth. No root fracture and root displacement emerged, and all roots were removed intact. Moreover, fracture of the alveolar process did not occur. Two cases with buccal mucosal injury were noted, which were because of heat injuries caused by the basement of the tip while cool water was used out.This study introduced a novel mini-invasive strategy for increasing space during teeth extraction. The advantage of this piezosurgery-associated flapless surgery included maximal preservation of the alveolar bone, minimal injury to soft tissues, and prevention of root fracture during the surgery. Furthermore, the cool water used during the surgery must be carefully checked before the procedure.

Radiographic Analysis of the Pediatric Hip Patients With Hereditary Multiple Exostoses (HME).

This study aimed to report the radiographic presentation of involved hips in children with hereditary multiple exostoses (HME). This included radiographic hip measurements, osteochondromas location, and relationship with hip subluxation. Anteroposterior pelvis radiographs of children with HME, seen between 2003 and 2014, were retrospectively reviewed. Only patients who were skeletally immature at the first visit were included. One radiograph per patient per year was reviewed. Radiographs were examined for the presence of osteochondromas and their locations. Different parameters were evaluated: femoral neck-shaft angle, Reimer migration percentage (MP), Sharp acetabular angle, Wiberg angle, femoral head-neck ratio (coronal plane), and Shenton line. All measured radiographs were divided into 3 age groups:≤8,>8 and <13, and ≥13 years. Differences of the measured parameters with age were evaluated. Children with hip subluxation were identified and any relationship with osteochondromas locations, as well as MP changes over time, was recorded. Radiographs of children with a minimum 2-year follow-up were identified and changes of their hip measurements and osteochondromas' presence over time were recorded. A total of 51 children (102 hips) with HME were identified. In most locations, there was an overall increase of the occurrence of osteochondromas in the older age groups. However, in the medial femoral neck, a significantly less numbers of osteochondromas were found after 13 years of age (P=0.018). There was a decrease in MP with age (P<0.05). There was also an increase in Sharp and Wiberg angles in the older patients (P<0.05). Hips with broken Shenton line decreased in number with age (P 0.028). Hip subluxation was encountered in 23 hips. No specific location of osteochondromas was found to have a relationship with subluxation. Thirty-six children had a minimum follow-up of 2 years (mean age at first visit 8.5 y and at last visit 13.1 y). In these children, an increased occurrence of lesions was found in medial femoral neck and ischium (P<0.05) between the first and the last visit. In children with HME, radiographic evaluation of the hip is necessary based on the high percentage of hip involvement. When hip osteochondromas are found, radiographic surveillance is recommended to detect hip subluxation. Surgery may certainly be necessary for symptomatic osteochondromas. However, given the possibility of improvement in hip parameters with age, early surgical treatment to improve hip longevity does not seem to be warranted. Level IV-prognostic study.

Medication related osteonecrosis of the jaw in osteoporotic vs oncologic patients-quantifying radiographic appearance and relationship to clinical findings.

To explore whether differences exist in the clinical and radiographic presentation of oncologic vs osteoporotic patients with medication-relatedosteonecrosis of the jaw (MRONJ). We retrospectively assessed panoramic radiographs and CBCT examinations of 70 MRONJ patients receiving antiresorptive medications for the management of either osteoporosis or bone malignancy. Radiographic features of MRONJ were documented and categorized according to severity. A composite radiographic index (CRI) was constructed to account for the heterogeneity in radiographic manifestations of MRONJ and further stratify extent of osseous changes. Patients with osteoporosis were mostly older females and presented more frequently with Stage 2 MRONJ, while patients with malignancy were equally distributed between males and females, and presented mostly with Stage 1 MRONJ. Most MRONJ lesions in oncologic patients occurred in the mandible, whereas the maxilla and mandible were equally affected in osteoporotic patients. Patients with minimal radiographic changes (low CRI score) often presented with MRONJ in dentate areas, while most patients in medium and high CRI groups presented with MRONJ after recent tooth extraction. The low CRI group consisted of primarily oncologic patients, while osteoporotic vs oncologic patients were divided more evenly in the other CRI groups (p = 0.083). While CRI scores increased with clinical staging, a Spearman's rank correlation coefficient of 0.49 suggests that clinical appearance does not reliably predict osseous changes. Our data identify differences in the MRONJ appearance of patients with osteoporosis vs malignancy and emphasize the significance of detailed radiographic assessment, in addition to the clinical appearance, in characterizing the osseous changes of the disease.

Unusual Radiographic Presentation of Primary Ewing Sarcoma of the Orbit

Unusual Radiographic Presentation of Primary Ewing Sarcoma of the Orbit