226 research outputs found
Comparison of Clinical, Instrumental and Imaging Methods in Diagnosis of Temporomandibular Disorders
Svrha: Osim kliničke procjene u ovom se radu željelo procijeniti i snimke kondilarnih kretnji dobivenih kompjutorskom aksiografi jom u slučaju temporomandibularnih poremećaja kod zdravih osoba i dislokacije diska te prema njihovoj težini rangirane MR-snimke tragova dobivenih u drugim položajima zgloba. Materijal i metode: Analizirano je 18 slučajeva s mišićnim poremećajima (16 ženskih i 2 muška pacijenta prosječne dobi 32,06±15,99) i 11 pacijentica (prosječna dob 25,27±10,05) kod kojih su na pregledu magnetskom rezonancijom bili uočeni različiti stupnjevi intrakapsularnih poremećaja. U kontrolnoj skupini bilo je 6 žena te 4 muškarca prosječne dobi 22,20±2,39. Svi su bili na kompjutorskoj aksiografi ji. Analizirane su i magnetske snimke pacijentata s intrakapsularnim poremećajima. Proučavani su i zvuk zgloba te raspon kretanja mandibule. Podaci su obrađeni statistički (Mann-Whitneyevim U testom, Student t-testom, One-way ANOVA-om i Chi-Squarom α=0,05). Rezultati: Razlike u kretnji otvaranja usta između (dviju) skupina s TMP-om i one kontrolne bile su neznatne (p=0,27). Kad je riječ o čeljusnim zglobovima, razlike između skupina s unutarnjim poremećajem i onih s mišićnim bile su također beznačajne (p=0,09). Kod asimptomatske kontrolne skupine duljina staze čeljusnih zglobova bila je uglavnom simetrična i normalnog raspona. Duljina staze kod skupine s mišićnim poremećajem bila je općenito slična onoj u kontrolnoj skupini, ali kretnje, kad su se ponavljale, nisu bile tako dobre kao kod kontrolne skupine. Duljine staze kod pacijenata s različitim stupnjevima poremećaja dijagnosticiranih magnetskom rezonancijom, bile su kraće od normalnih i bilo je odstupanja, pa i križanja puteva. Zaključak: Osim pažljivog kliničkog pregleda, koristile su se i dijagnostičke tehnike temeljene na promjeni funkcije te sustavi za analizu slika. Koštane strukture, posebice meka tkiva čeljusnih zglobova, mogu se pregledati magnetskom rezonancijom te se može ocijeniti njihov međusobni odnos. Kod metode koja daje podatke o funkcionalnom stanju zgloba, mogu se dobiti objektivni podaci te odrediti postupak liječenja.Objective: In addition to the clinical evaluation, it was aimed to assess the traces obtained by computerized axiography of the condylar movements in temporomandibular disorders (TMD) in healthy individuals together with disc displacements and staged MRI images of these traces obtained in other joint positions. Material and Methods: 18 cases with muscle disorders (16 women and 2 men with mean ages; 32.06±15.99) and 11 cases (11 women, mean age 25.27 ±10.05) observed to have intraarticular disorders at different degrees as a result of MRI evaluation. The control group consisted of 10 cases (6 women and 4 men with mean ages; 22.20 ±2.39). Computerized axiography recordings of all cases were taken. MRI images taken from the cases with intraarticular disorders were evaluated. Joint sounds and mandibular range of motion were evaluated. Data were analyzed statistically. (Mann Whitney-U, Student t-test, One-way ANOVA and Chi-Square α=0.05). Results: The differences between TMD groups and control groups as regards the degrees of mouth opening movement were insignificant (p=0.27). The difference between the internal derangement and muscle disorder groups regarding TMJ sounds were insignificant (p=0.09). The length of the tracings of the asymptomatic control group as regards TMJs was generally symmetrical and in normal range. The tracings of the muscle disorder group were generally similar to those of the control group, however, the reproducibility of the movement was not as good as that in the control group. The tracings of patients with different stages as diagnosed by MRI were shorter than normal, and deviations on pathways in all cases, and crossings in some, were observed. Conclusion: In addition to careful clinical evaluation, function-based diagnosis techniques and imaging systems were utilised. Bony structures and especially soft tissues of the TMJ can be examined by means of MRI and the relations of the tissues with each other can be evaluated. In the method rendering information about the functional condition of the joint, objective data can be filed and the process of treatment can be evaluated
Evaluation of Diffusion Tensor Imaging Findings in Clinically Isolated Syndrome and Relapsing-Remitting Multiple Sclerosis Patients
Objective: To compare diffusion tensor imaging (DTI) findings of the normal-appearing white matter (NAWM) and corpus callosum (CC) in patients with clinically isolated syndrome (CIS) and relapsing-remitting multiple sclerosis (RRMS) and a healthy control (HC) group. Materials and Methods: The CIS (n = 10), RRMS (n = 29), and HC (n = 13) groups were evaluated by DTI in this retrospective study. Mean diffusion (MD) and fractional anisotropy (FA) maps as well as MD and FA measurements were made from the corpus callosum genu (CCG), corpus callosum splenium (CCS), and NAWM areas from the frontal, parietal, occipital and temporal lobes. Results: The mean FA values of the NAWM in the temporal lobes were bilaterally lower in both the CIS and RRMS groups than in the HC group. However, no difference was found between the CIS and RRMS groups. In addition, the CIS group had lower FA values in the CCG, whereas the RRMS group had lower FA values in the CCS compared with the HC group. The MD values were significantly different in the CCG between the RRMS and HC groups. Conclusion: DTI contributes to detecting early changes in the NAWM and CC in patients diagnosed with CIS and RRMS. Additionally, DTI can aid in the follow-up care and management of these patients
Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study
Objectives. Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations.Methods. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses.Results. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P < 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P < 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P < 0.001) diffuse skin involvement than had WP.AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P < 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P < 0.001; OR(BP) = 2.4, P < 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P < 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P < 0.001].Conclusion. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality
Global Retinoblastoma Presentation and Analysis by National Income Level.
Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs
The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries
DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt
Multipl Skleroz (MS) hastalarında motor uyaranlara karşı beyinde oluşan aktivite değişikliklerinin fonksiyonel Manyetik Rezonans Görüntüleme (fMRG) ile değerlendirilmesi
Serebral iskeminin difüzyon MR değerlendirilmesi ve ADC deki intensite değişikliklerinin enfarktın evolüsyonu ile ilişkisinin araştırılması
Klinik izole sendrom ve relapsing remmitting multiple skleroz hastalarında diffuzyon tensor görüntüleme bulgularının değerlendirilmesi
hafif kognitif yıkım olan hastalardafonksiyonel manyetik rezonans görüntüleme bulgularının araştırılması
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