Comparison of 1-year results of single transforaminal epidural steroid injection among patients with different spinal pathologies-related radicular pain.

AIMS: This study aims to investigate the effectiveness of transforaminal epidural steroid injection (TFESI) in patients with lumbar radicular pain or radiculopathy caused by different spinal pathologies. METHODS: One hundred and seventy seven patients who underwent single transforaminal epidural steroid injection were included in the study group and divided into 3 subgroups (central spinal stenosis + lateral recess stenosis, foraminal stenosis, lumbar disc herniation) according to existing spinal pathology. Patients' visuel analogue scale (VAS) measures and Oswestry Disability Index (ODI) scores were recorded and the patients who give favourable response to treatment were called respondents and who were not called as non-respondents. Subgroups were compared statistically at the end of 12 months. RESULTS: Sixty patients (33.9%) were considered as respondents and 117 patients (66.1%) were non-respondents in the entire study group. Patients with foraminal stenosis included the vast majority of the respondents and showed better results of pain relief as opposed to patients of other groups at the end of 12 months (P < 0.001). CONCLUSION: TFESI was an effective treatment modality for pain relief and functional improvement in patients with foraminal stenosis. However, it could not produce the same results in patients with central spinal stenosis and lumbar disc herniations.

A comparison of intravenous sugammadex and neostigmine + atropine reversal on time to consciousness during wake-up tests in spinal surgery.

OBJECTIVE: The effect of sugammadex on consciousness is not yet fully understood. This prospective, randomized, double-blind, multicenter study was performed to compare the effects of intravenous (IV) sugammadex and neostigmine + atropine reversals on time-to-consciousness during intraoperative wake-up tests in patients undergoing spinal surgery. SUBJECTS AND METHODS: A total of 66 American Society of Anesthesiologists I-II patients aged 10-25 years undergoing spinal surgery were recruited. In all patients, bispectral index (BIS), motor-evoked potential (MEP), somatosensory-evoked potentials (SSEP), and train-of-four (TOF) scores were monitored. Patients received the same total IV anesthesia protocol with a propofol-remifentanil mixture. Patients were randomly allocated into two groups. During wake-up test, when the TOF count reached 2 (T2), either sugammadex 2 mg.kg-1 in group S or neostigmine 0.04 mg.kg-1 + atropine 0.01 mg.kg-1 in group N were administered. BIS90, SSEP90, MEP90 was recorded when TOF ratio reached 90, whereas time-to-consciousness (Timecons) was recorded when the patient responded to verbal commands. RESULTS: BIS90 (77.4 ± 4.7, 74.8 ± 3.7), SSEP90(36 ± 9.9, 29.7 ± 8.5), and MEP90 (465.3 ± 34.8, 431.3 ± 28.2) values were significantly greater in group S than in group N (P < 0.05 for each variables). Timecons was significantly shorter with sugammadex than with the neostigmine + atropine combination (P < 0.05). CONCLUSION: Using IV sugammadex 2 mg.kg-1 reversal provides faster responses to verbal commands than neostigmine-atropine combination during the intraoperative wake-up test in patients undergoing spinal surgery because the time to consciousness was significantly shorter. This difference was thought to be related with faster return of neuromuscular transmission because the TOF ratio was >0.9 well before return of consciousness in both groups.

Is acute compression and distraction superior to segmental bone transport techniques in chronic tibial osteomyelitis ? Comparison of Distraction Osteogenesis Techniques.

Treatment of tibial osteomyelitis with infected, necrotic, unstable bone segments (Cierny-Mader Type IV local osteomyelitis) includes débridement and segmental resection, which results in long bone defects. Reconstruction may be with distraction osteogenesis. Segmental bone transport and acute compression and distraction techniques are two main distraction osteogenesis techniques used in the treatment of Type IV local tibial osteomyelitis. In this retrospective, four-center study we compared these two techniques during a 15-year period. 29 patients treated using segmental bone transport technique and 45 patients were treated using acute compression and distraction technique. The mean age (p= 0,34) and the mean bone loss with preoperative shortening (P=0,08) and the mean number of previous operation (p=0,06) were not different in these two groups. . At latest followup, functional and radiographic results were evaluated There was no difference between two technique on the Paley's scoring system ( p=0,33) and in the total number of complication(p=0,16). Mean external fixator index was lower in the second group ( p=0.02 ). Both techniques can be used safely; however, the acute compression distraction technique may provide greater patient satisfaction because of shorter external fixator index, although future studies will be needed to determine whether this is.

Prognostic factors affecting the outcome of arthroscopic saucerization in discoid lateral meniscus: a retrospective analysis of 48 cases.

PURPOSE: The purpose of this retrospective study was to evaluate the results and prognostic factors affecting the outcome of arthroscopic saucerization for discoid lateral meniscus (DLM). METHODS: Forty-eight patients who underwent arthroscopic saucerization for DLM between January 2009 and January 2012 in two hospitals were included. There were 21 (43.8%) male and 27 (56.3%) female patients with a mean age of 36.02 ± 14.5 (range 9-65) years at the time of operation. According to Watanabe classification, 33 (68.7%) patients had type II (incomplete) discoid meniscus and 15 (31.3%) had type I (complete) discoid meniscus. Of the 48 patients, 26 (54.2%) had an associated lateral meniscal tear. Seventeen patients (35.4%) had accompanying ligamentous, chondral and/or medial meniscal lesions. The symptoms were present for a mean of 8.04 ± 4.48 (range 1-24) months before the operation. All patients were followed up with a mean of 27.7 ± 10.7 (range 12-47) months using Lysholm knee score. We analyzed the relationship between the outcome variable (Lysholm knee score at the final follow-up) and the predictor variables (age, gender, type of DLM, presence of meniscal tear, duration of symptoms, follow-up and accompanying intra-articular lesions). RESULTS: The mean preoperative Lysholm knee score was 46.6 ± 10.2 points and increased to 85.08 ± 13.45 points at the final follow-up (p = 0.0001). Twenty (41.7%) excellent, seven (14.6%) good, nineteen (39.6%) fair and two (4.2%) poor results have obtained. No complications were observed in any patient. Regression analysis showed that age was the only predictor of the Lysholm score at the final follow-up (R2 = 0.545, p = 0.0001). The linear regression equation was (Lysholm score at final follow-up) = 106.1 - [0.58 × (age of patient)]. CONCLUSIONS: This study demonstrated that arthroscopic saucerization is an effective and safe treatment modality for DLM. Furthermore, age of the patient was shown to be the most important prognostic factor over the final clinical outcome. An excellent or a good result can be expected when the patient is young at the time of operation. LEVEL OF EVIDENCE: IV.

Bladder pheochromocytoma encountered on sonography.

Pheochromocytomas of the bladder are rare neoplasms, constituting < 0.06% of all vesical tumours. Common presenting features of this tumour include episodes of sweating, hypertension, haematuria and postmicturition syncope. We describe a case of bladder pheochromocytoma in a 66-year-old man whose only symptom of macroscopic haematuria was initially assessed with ultrasonography. Clinical presentation highlights the need for a high index of suspicion during sonographic evaluation of bladder neoplasms because such tumours might present without symptoms of adrenergic excess.

Primary and metastatic rhabdomyosarcoma in the breast: report of two pediatric cases.

Rhabdomyosarcoma (RMS) is a common childhood malignancy which can rarely be located in the breast. Here, we report two pediatric cases of breast RMS, one primary, the other secondary involvement. Primary one is alveolar, and the other embryonal subtype. Imaging findings with ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) and a thorough review of literature are presented.

Utility of color duplex sonography in the assessment of efficacy of the stellate ganglion blockade.

PURPOSE: To assess the hemodynamic changes in the upper extremity arteries after sympathetic ganglion blockade (SGB) by using spectral Doppler parameters and to determine the applicability of these parameters for the evaluation of SGB efficacy. MATERIAL AND METHODS: Spectral Doppler parameters (peak systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (mean V), flow volume, resistive and pulsatility indices (RI, PI), inner arterial diameters (intima to intima) (D) with simultaneous recordings of heart rate (HR), systolic and diastolic blood pressures and upper extremity surface temperature changes) were recorded before and 5 min after during the first, fifth and tenth SGB procedures. RESULTS: SGB induced an increase in skin temperature in the ipsilateral hand and persistent dilatation of the radial diameter accompanied by reduction of RI and PI in the radial and third digital arteries in all patients. CONCLUSION: Hemodynamic changes assessed by spectral Doppler parameters could be used as sensitive and objective measurements of peripheral sympathetic nervous activity and vascular tonus, and may confirm a successfully performed SGB.

Osteopenia and osteoporosis in postmenopausal women. Assessment by radiogrammetric measurement.

PURPOSE: To compare the ability of the medial cortical thickness ratio to the width of the second metacarpal bone at the midshaft (MCR) in discriminating patients as normal, osteopenic or osteoporotic. MATERIAL AND METHODS: MCR was calculated from radiographs of 120 postmenopausal women. By dual-energy X-ray absorptiometry, the mineral density was measured in the lumbar spine, the wrist and the femoral neck. Patients were grouped in accordance with the diagnostic criteria of WHO on the basis of t-scores. MCR values were compared with t-scores and the ability of the MCR technique in discriminating the patient groups was evaluated. RESULTS: Analysis of radiogrammetric data revealed significant differences in MCR value between the 3 groups. The MCR was lower in patients with osteoporosis and osteopenia compared with the normal group. The mean value of MCR was also slightly lower in patients with osteoporosis than in those with osteopenia. Accuracy assessment (ROC analysis) of MCR in the discrimination of patients with osteoporosis showed that test accuracy was acceptable, but less accurate than spinal, wrist and femoral neck t-scores. Compared with t-scores, this test was found to fairly discriminate those with and without osteopenia. CONCLUSION: The MCR method can discriminate patients as osteoporotic or normal. However, it seems that the MCR method should not be used for decisions concerning treatment of osteoporosis because of its low accuracy and thereby a risk for misclassification.

Secondary involvement of breast with non-Hodgkin's lymphoma in a paediatric patient presenting as bilateral breast masses.

We report a paediatric case of non-Hodgkin's lymphoma with secondary breast involvement. On US exam there were bilateral multiple well-defined masses. Contrast-enhanced thorax CT demonstrated the breast lesions as well as enhancing masses. To our knowledge, this type of lymphomatous breast involvement in a child is rare and its CT features are very rarely demonstrated.

Fine needle aspiration cytology of hepatoblastoma. A report of two cases.

BACKGROUND: Hepatoblastoma is the most common primary hepatic tumor in children. The literature contains few examples of fine needle aspiration (FNA) cytology of these tumors. CASES: A 5-month-old and 4-month-old underwent ultrasonography-guided FNA for the preoperative investigation of hepatic masses. The smears were stained with May-Grünwald-Giemsa and Papanicolaou stain. Alcohol-fixed smears were used for immunocytochemistry. All smears revealed cells with round/oval nuclei, prominent nucleoli and vacuolated cytoplasm, arranged in groups and acinar structures. The groups were embedded in a myxoid stroma. alpha-Fetoprotein was positive in all, and vimentin was positive in some tumor cells. The cytologic findings resembled the histologic counterpart in one case, and the other case agreed with the clinical/radiologic prediagnosis. Immunocytochemistry was supportive. CONCLUSION: FNA cytology can be diagnostic in many other childhood tumors as well as hepatoblastomas. Detailed descriptions of cytomorphologic features of hepatoblastoma will help FNA to be used confidently on these tumors.