HIGH RESOLUTION COMPUTED TOMOGRAPHY IN THE EVALUATION OF TEMPORAL BONE PATHOLOGY

Introduction: The temporal bone is a complex anatomic structure that contains the organs of hearing and balance and has direct contact with brainstem, cerebellum and temporal lobe of brain. Radiographic assessment of temporal bone is difficult owing to complicated anatomical structure of middle and inner ear. High resolution computed tomography (HRCT) - a modification of routine CT produces images with higher contrast and a better spatial resolution. HRCT has the advantage of topographic visualization, devoid of artifacts from superimposition of structures. It provides information not only about bony outline but also soft tissue changes making it possible for the accurate assessment of pathology prior to surgical exploration regarding location, extent and complication of the disease. Material and methods: This was a cross sectional study of 50 patients who were clinically suspected of having symptoms related to the temporal bone like hearing loss, otorrhea, otalgia, tinnitus, vertigo, ear bleed, cranial nerve palsies, fever, ataxia etc were referred and subjected to HRCT of the temporal bone at Geetanjali Medical College and Hospital (Udaipur) between Nov 2017 and June 2019. Results: CSOM and Cholesteatoma were the most common diseases found by HRCT and Intra-op/Follow-up scan followed by Fractures, acoustic neuroma, Glomus tympanicum and Atretic EAC. Almost all the lesions were correctly detected by HRCT when confirmed with Intra-op/follow up findings. Conclusion: HRCT can very accurately detect Temporal bone pathology. Keywords: HRCT, CSOM, CT

Skeletal Scintigraphy in Assesing the Response of Prostate Cancer Metastases to Androgen Deprivation Therapy

Androgen deprivation therapy (ADT) with luteinizing hormone-releasing hormone agonists is the basis for drug treatment in patients with metastatic prostate cancer (PC). An accurate assessment of the response of the tumor and its metastases is of primary importance for making a clinical decision regarding the continuation of treatment, changing the line of drugs or the nature of therapy. The presented clinical case illustrates the possibilities of 99mTc-pyrophosphate skeletal scintigraphy for monitoring the response of PC bone metastases to ADT. The efficiency of hormone therapy with Triptorelin has been confirmed by positive changes in the visual and quantitative scintigraphic signs that manifest the metabolic activity of bone tissue in the area of a metastatic lesion. This was manifested by a marked decrease in the intensity of 99mTc-pyrophosphate accumulation in the foci of bone pathology, by a reduction in the number of visualized hot foci, and by a gradual normalization of the scintigraphic pattern. This variant of the metabolic response of bone metastases to ADT correlated with the positive changes in laboratory parameters, as well as with the signs of reversal of the tumor and its metastases, as evidenced by magnetic resonance imaging.

Osteonecrosis Development Post Covid-19 Infection

The COVID19 pandemic, originating in China, has spread across the world, with serious proportions in populations and public health. Systemic lesions in those infected generate cascading changes affecting different organs. Osteonecrosis is a bone pathology, of different etiologies, common throughout the world, which directs the hip to a disabling condition. Furthermore, there is a polygenic and multifactorial interaction in its pathophysiology. The objective of this paper is to present the first series of cases of osteonecrosis of the femoral head after infection by SARS-CoV-2 and to discuss the possible pathological mechanisms. This is a sample with a male majority with a mean age of 43.5 years, bilateral involvement of the hip sin 100% of cases, mean time between infection and onset of symptoms was 132.8 days. About 33% had osteonecrosis of the femoral head after a mild infection, 66% were moderate or severe cases that used corticosteroid therapy with a minimum dose of 40mg/day of dexamethasone for an average time of 14.6 days. We believe that the association of hypercoagulability mechanisms inherent to COVID-19, direct cell infection and instituted cortico therapy may be responsible for the high incidence of osteonecrosis in the post-covid syndrome.

Five-year experience in surgical treatment of temporal bone paragangliomas

Objectives to discuss a five-year experience in surgical treatment of temporal bone paragangliomas from the point of view of U. Fisch and D. Mattox classification modified by М. Sanna in 2013. Material and methods. In the period from February 2015 till December 2020, we performed 130 operations to remove temporal bone paraganglioma. The examined and operated patients included 34 men and 96 women aged from 2 to 82 years. The paraganglioma types A, B and C were distributed as follows: type A in 22 patients (A1 12 cases, A2 10 cases); type B in 73 patients (B1 25 cases, B2 16 cases, B3 32 cases); type C in 35 patients (С1 10 cases, С2 12 cases, С3 7 cases, С4 5 cases) Results. The evaluated results included the quality of tumor removal, the auditory function and the function of the facial nerve in relation to the size of the neoplasm, registered during the early and late postoperative periods. Based on the study data, we developed an algorithm of tactics of surgical treatment of patients with this type of temporal bone pathology aimed to avoid damage to the vital structures of the lateral skull base.

A Very Rare Fracture: Isolated Fresh Lunate Fracture

Lunate fractures are rare and usually occur together with other fractures, dislocations, or ligament disruptions. We want to report an acute fresh isolated lunate fracture without additional ligamentous injury fixated with early surgical intervention. A 23-year-old right-hand-dominated male patient was admitted to our hospital after falling from 1.5-meter ladder over right hand’s palmar face. Standard radiographs diagnosed a displaced lunate fracture. In the intraoperative evaluation, it was observed that there was only lunate dislocation, and there was no ligament lesion or other carpal bone pathology. Fracture was fixed with a headless cannulated screw. Radiographs showed bony union at 6-week follow-up. There was no evidence for Kienböck’s disease 6 months after surgery. Case report regarding fresh isolated lunate fracture that results in clinical success with early intervention without developing avascular necrosis as in our report is extremely rare. In conclusion, satisfying results can be obtained in these patients with careful surgical intervention.

Synthesis, Complexation Properties, and Evaluation of New Aminodiphosphonic Acids as Vector Molecules for 68Ga Radiopharmaceuticals

Two new aminodiphosphonic acids derived from salicylic acid and its phosphonic analogue were prepared through a simple and efficient synthesis. 2-[(2-Amino-2,2-diphosphono)ethyloxy]-benzoic acid 8 and 2-[(2-amino-2,2-diphosphono)ethyloxy]-5-ethyl-phenylphosphonic acid 9 were evaluated for their applicability as 68Ga binding bone-seeking agents. Protonation constants of 8 and 9 and stability constants of the Ga3+ complexes with 8 and 9 in water were determined. The stability constant of Ga3+ complex with fully phosphorylated acid 9 (logKGaL = 31.92 ± 0.32) significantly exceeds stability constant of Ga3+ complex with 8 (logKGaL = 26.63 ± 0.24). Ligands 8 and 9 are as effective for Ga3+ cation binding as ethylenediamine-N,N’-diacetic-N,N’-bis(methy1enephosphonic) acid and ethylenediamine-N,N,N’,N’-tetrakis(methylenephosphonic) acid, respectively. The labelling process and stability of [68Ga]Ga-8 and [68Ga]Ga-9 were studied. Both 8 and 9 readily form 68Ga-complexes stable to ten-fold dilution with saline. However, in fetal bovine serum, only [68Ga]Ga-9 was stable enough to be subject to biological evaluation. It was injected into rats with bone pathology and aseptic inflammation of soft tissues. For [68Ga]Ga-9 in animals with a bone pathology model in 60 and 120 min after injection, a slight accumulation in the pathology site, stable blood percentage level, and moderate accumulation in the liver were observed. For animals with an aseptic inflammation, the accumulation of [68Ga]Ga-9 in the pathology site was higher than that in animals with bone pathology. Moreover, the accumulation of [68Ga]Ga-9 in inflammation sites was more stable than that for [68Ga]Ga-citrate. The percentage of [68Ga]Ga-9 in the blood decreased from 3.1% ID/g (60 min) to 1.5% ID/g (120 min). Accumulation in the liver was comparable to that obtained for [68Ga]Ga-citrate.