Assessment of magnetic resonance imaging role in evaluation of failed back surgery syndrome

Background: Failed back surgery syndrome (FBSS) is a fairly common problem. Magnetic resonance imaging (MRI) with its multi-planar capabilities and superior soft tissue characterization is the modality of choice for imaging the postoperative spine.Objective: This study aimed to investigate the role of MRI in evaluation of FBSS.Methods: Forty-eight patients with FBSS were referred to Zagazig University Hospitals who had previous lumbar spine surgery. All patients were evaluated by history taking and radiological evaluation by dynamic x-ray and a post-operative spine MRI study that consisted of seven series: T1 -weighted sagittal & TI -weighted axial series, a sagittal & axial series for T2-weighted series, post-gadolinium T1-weighted axial and sagittal series and Heavy T2 MRI myelogram.Results: The major identifiable causes of FBSS in operated patients for lumbar disc herniation included recurrent disc herniation and epidural fibrosis (27 and 10.4% of our patients, respectively), and both occurred in 22.9 %, post-operative infected fluid collection in 10.4%, spondylodiscitis in 6.3%, spondylodiscitis with epidural fibrosis in 4.2%, filum terminal ependymoma and postoperative infected fluid collection with epidural fibrosis in 4.2%, postoperative infected fluid collection with spondylodiscitis in 4.2%, epidural fibrosis with spinal stenosis in 4.2%, pseudo- meningocele with RDH in 2%, both epidural scar & RDH with deposits in 2% and RDH with spinal stenosis in 2%.Conclusion: MRI is generally a safe and accurate technique, which has been proven to be the technique of choice in evaluation of FBSS with its excellent resolution and multi-planar capabilities

Bilaterality of varicocele: The overlooked culprit in male infertility. Case series study

Objectives: Varicocele is the most common correctable cause of male infertility that always has been a debatable subject as regards how it affects fertility and the best way to treat it. Proper assessment of the disease bilaterality is crucial not to miss one side and not to jeopardize treatment outcome. This study aimed to objectively assess varicocele bilaterality in infertile men aiming to improve treatment outcome in this cohort of patients. Methods: This prospective study was conducted between January 2019 and January 2022 including infertile males with varicoceles. Assessment of missed concomitant contralateral varicocele done pre-operatively by Color Doppler Ultrasound and intraoperatively by intraoperative Doppler device and measurement of maximal vein diameter of contralateral side. Results: A total of 329 cases completed the study. A hundred cases (30.4%) were initially referred as unilateral varicoceles and 229 (69.6%) as bilateral varicoceles. After reassessment of the study population, bilaterality of varicocele was found to be as high as 98.5% (324/329). Repeat CDUS strongly correlated with the intraoperative measured varicocele diameter (r = 0.9, p < 0.001). Moreover, sperm parameters showed significant improvement 3 and 6 months post varicocelectomy. Normal pregnancy after 1 year of surgery occurred in 118 cases (35.9%). Conclusions: Varicocele bilaterality in infertile men is underreported. Thorough assessment by expert radiologists and andrologists is of paramount importance not to miss significant pathology or hazard treatment outcome

Development and implementation of the AIDA International Registry for patients with Periodic Fever, Aphthous stomatitis, Pharyngitis, and cervical Adenitis syndrome

Objective: Aim of this paper is to illustrate the methodology, design, and development of the AutoInflammatory Disease Alliance (AIDA) International Registry dedicated to patients with the Periodic Fever, Aphthous stomatitis, Pharyngitis, and cervical Adenitis (PFAPA) syndrome. Methods: This is a physician-driven, non-population- and electronic-based registry proposed to gather real-world demographics, clinical, laboratory, instrumental and socioeconomic data from PFAPA patients. Data recruitment is realized through the on-line Research Electronic Data Capture (REDCap) tool. This registry is thought to collect standardized information for clinical research leading to solid real-life evidence. The international scope and the flexibility of the registry will facilitate the realization of cutting-edge study projects through the constant updating of variables and the possible merging and transfer of data between current and future PFAPA registries. Results: A total of 112 centers have already been involved from 23 countries and 4 continents starting from August 24th, 2021, to April 6th, 2022. In total 56/112 have already obtained the formal approval from their local Ethics Committees. The platform counts 321 users (113 principal investigators, 203 site investigators, two lead investigators, and three data managers). The registry collects retrospective and prospective data using 3,856 fields organized into 25 instruments, including PFAPA patient's demographics, medical histories, symptoms, triggers/risk factors, therapies, and impact on the healthcare systems. Conclusions: The development of the AIDA International Registry for PFAPA patients will enable the on-line collection of standardized data prompting real-life studies through the connection of worldwide groups of physicians and researchers. This project can be found on NCT 05200715