Is there any effect of presence and size of os trigonum on flexor hallucis longus tendon lesions?

BACKGROUND: It was hypnotized that presence and larger size of os trigonum (OT) can affect flexor hallucis longus tendon (FHL), so tenosynovitis, degeneration and partial tear can be developed. METHODS: A total of 98 (Study group: 50, Control: 48) subjects included to study and compered status of FHL lesions. Sagittal length and axial width of OT were measured on MRI to determine effect of OT on FHL lesions and correlated with arthroscopic findings. RESULTS: FHL tenosynovitis (p: 0,025), degeneration (p: 0,01) and partial tear (p: 0.008) was identified statistically high in study group. Statistical analysis revealed that as length of OT increased, frequency of degeneration (p: 0.03) and partial tear (p: 0.00) of FHL increased. CONCLUSION: Analyzes were showed that the presence of os trigonum had an important role on the FHL pathologies. Additional finding of study was to demonstrate that possibility of FHL lesion increased as length of OT extended. LEVELS OF EVIDENCE: Level 3.

Impact of adenotonsillectomy on ADHD and nocturnal enuresis in children with chronic adenotonsillar hypertrophy.

OBJECTIVE: Children with chronic adenotonsillar hypertrophy (CAH) are more likely to have symptoms of attention deficit hyperactivity disorder (ADHD) and enuresis nocturna (EN) and benefit from surgery. The aim of this study was to evaluate the effect of adenotonsillectomy on ADHD and EN symptoms in children with CAH. STUDY DESIGN: Cross-sectional study was conducted. SETTING: Parent-based questionnaires. METHODS: Parents of children with CAH were given Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV) and Nocturnal Enuresis Questionnaire (NEQ) before and six months after adenotonsillectomy. Inattention (IA) and hyperactivity-impulsivity (HI) subscores of T-DSM-IV were used in the present study. The rates of ADHD and EN were compared before and after surgery. RESULTS: A total of 75 children between 5 and 16 years of age and their families participated in the study. All 75 families completed T-DSM-IV and NEQ. Mean IA (5.69 ± 4.88 versus 4.46 ± 4.40) and HI (6.53 ± 5.60 versus 5.93 ± 5.45) scores as well as total ADHD scores (12.22 ± 8.99 versus 10.42 ± 8.70) improved significantly after surgery. This significance was found to be statistically important (p<0.05). Furthermore 26 of the subjects were diagnosed with primer EN before adenotonsillectomy and 14 of these enuretic children had total remission six months after surgery. The frequency of EN dropped from 34.7% to 16.0% and this remission rate was found to be statistically significant (p<0.05). CONCLUSION: Children with CAH had high frequency of ADHD and EN symptoms in the present study. Adenotonsillectomy was found to be effective in improvement of these symptoms.

High psychiatric comorbidity in adolescents with dissociative disorders.

AIM: The aim of this study was to evaluate psychiatric comorbidity rates and patterns in a sample of clinically referred adolescents diagnosed with dissociative disorders (DD) by using a structured interview. METHODS: All participants completed a comprehensive test battery, which consisted of a questionnaire for sociodemographic data and clinical history, Child Posttraumatic Stress Reaction Index, Childhood Abuse and Neglect Questionnaire and the Adolescent Dissociative Experiences Scale. Diagnosis was made by the Structured Clinical Interview for DSM-IV Dissociative Disorders. Psychiatric comorbidity was assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children - Present and Lifetime Version. RESULTS: A total of 25 adolescent subjects aged 12-18 years participated in the study. Ten adolescents were diagnosed as having dissociative identity disorder and 15 of them were diagnosed as having dissociative disorder-not otherwise specified based on the Structured Clinical Interview for DSM-IV Dissociative Disorders findings. Adolescents with dissociative identity disorder were found to have higher scores on the Adolescent Dissociative Experiences Scale and Child Posttraumatic Stress Reaction Index than the dissociative disorder-not otherwise specified group. Sexual and physical abuses were also found to be among the main traumatic events. Incest was reported in six cases of the study sample. All subjects had at least one comorbid psychiatric disorder. The most common psychiatric diagnoses were major depressive disorder (n = 25; 100%) and post-traumatic stress disorder (n = 22; 88%). CONCLUSION: High psychiatric comorbidity rates were found in adolescents diagnosed with DD. A prevalent history of abuse and traumatic events was represented. Clinicians should be aware of the impacts of DD on adolescents' mental health.

Evaluation of social and demographic characteristics of incest cases in a university hospital in Turkey.

BACKGROUND: Incest is defined as any sexual activity between close blood relatives including step relatives and family members who are forbidden by law to marry. It is a problem that can be seen in all the social classes in developed and undeveloped societies. The World Health Organization classifies this problem as a silent health emergency. Father-daughter incest is reported to be the most common incest type followed by the other types like brother-sister, sister-sister and mother-son incest. MATERIAL AND METHODS: Subjects for this study were recruited from a sample of incest cases referred to Forensic Medicine Department of Gaziosmanpasa University Medical Faculty Hospital between 2008 and 2012. Data involved social and demographic characteristics and clinical features of victims, perpetrators and the families. The ethical committee of the faculty of medicine approved the study. RESULTS: The study sample consisted of 43 incest cases (36 females and 7 males) with an age rage 4-40 years. Two third of the victims were under 18 years old. All perpetrators were males. Father - daughter incest (34.9%) was found to be most common incest type followed by brother - sister incest (14%). 75% of the perpetrators were family members and relatives with consanguinity while 25% of them were not consanguineous but faithful and intimate relatives to victims. CONCLUSIONS: Increasing awareness about incest and its damaging effects is so important and clinicians should keep in mind sexual abuse or incest when examining the risky population. Multidisciplinary approach is necessary for determining short term or long term results and preventing the negative consequences of incest.

Prevalence and patterns of psychiatric disorders in referred adolescents with Internet addiction.

AIM: To investigate prevalence and patterns of psychiatric disorders in young subjects with Internet addiction (IA). METHODS: Subjects were taken from a sample of patients, aged 10-18 years old, referred to Istanbul Medical Faculty, Child and Adolescent Psychiatry Department due to a variety of behavioral and emotional problems alongside problematic Internet use. Inclusion criteria included IQ ≥70 and score ≥80 on Young's Internet Addiction Scale (YIAS). Psychiatric comorbidity was assessed using the Turkish version of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version. RESULTS: Subjects were 45 boys (75%) and 15 girls (25%) with an age range of 10-18 years old (mean age, 13.38 ± 1.79 years). A total of 60% (n = 36) had been using Internet for ≥5 years. Mean hours/week spent on the Internet was 53.7 (range, 30-105 h) and the average YIAS score was 85. All subjects (100%) had at least one and 88.3% (n = 53) had at least two comorbid psychiatric disorders. The frequency of diagnostic groups were as follows: behavioral disorder, n = 52 (86.7%); anxiety disorder, n = 43 (71.7%); mood disorder, n = 23 (38.3%); elimination disorder, n = 16 (26.7%); tic disorder, n = 10 (16.7%); and substance use disorder, n = 4 (6.7%). The most common psychiatric disorders were attention-deficit hyperactivity disorder (n = 53; 83.3%), social phobia (n = 21; 35.0%) and major depressive disorder (n = 18; 30.0%). CONCLUSION: High rates of psychiatric comorbidity, particularly behavioral, anxiety and mood disorders were found in young subjects with IA. Because the presence of psychiatric disorders may affect the management /prognosis of IA, assessment should include that for other psychiatric disorders.

Psychological adjustment, maternal distress, and family functioning in children with obstetrical brachial plexus palsy.

PURPOSE: To examine emotional and behavioral characteristics of children with obstetrical brachial plexus palsy (OBPP), psychological distress of their mothers and their family functioning, and compare them with healthy peers. METHODS: Participants included 42 children with OBPP (22 boys, 20 girls; age range, 4-16 y; mean, 7 y 0 mo; SD, 3 y 3 mo) and 43 healthy controls (24 boys, 19 girls; age range, 4-15 y; mean, 8 y 0 m; SD, 3 y 0 mo). Childhood Behavior Checklist, Symptom Checklist 90, and Family Assessment Device were filled in by the mothers. RESULTS: Participants with OBPP displayed higher problem scores than the comparison children in most of the domains, including internalizing and externalizing problems. Maternal distress was higher in the OBPP group, and few differences in family functioning were noted. Maternal distress and having the diagnosis of OBPP were the strongest predictors of children's total problem scores and explained 26% of the variance when the effect of age, sex, and family functioning were controlled. CONCLUSIONS: Children with OBPP and their mothers are at increased risk for a variety of psychological problems. Professionals should be aware of these children's and their caregivers' psychological adjustment and refer them for further psychological support when needed. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Acute renal failure due to uterine prolapse: a case report.

Herein, we present a successfully treated case with acute renal failure due to ureteral obstruction caused by total uterine prolapsed. A 55-year-old female patient presented to our hospital with the complaints of protrusion of the uterus for the last 3 months, pollakiuria, nocturia, decreased urine volume, and swelling of her body for the last week, and as well as impaired general status with shortness of breath for the last several days. Her physical examination revealed a blood pressure of 140/90 mmHg, pulse rate of 80 beats/min, body temperature of 37.8 °C, as well as uterine prolapse with infection and erosion on the surface of the uterus, crepitating rales in the basal segments of both lungs, and pretibial edema. Results of laboratory analyses were as follows: BUN = 70 mg/dL, Cr = 6.5 mg/dL, CRP = 8.7 mg/dL, and leukocyte = 12,000/mm(3). Blood gas analysis revealed a pH of 7.35 and bicarbonate level of 14 mmol/L. Data obtained from ultrasonography, DTPA scintigraphy, and abdominal CT, which were performed assuming that the patient had post-renal renal failure due to the compression by uterus, supported this assumption. Bilateral nephrostomy catheters were inserted and appropriate fluid-electrolyte therapy for volume status and antibiotherapy were commenced. Renal functions returned to normal levels on the 4th day of therapy and her complaints disappeared. The patient underwent total abdominal hysterectomy and was monitored in terms of renal functions and diuresis. The present case was presented due to its importance for being a quite rare case who dramatically responded to accurate intervention performed in time.

Is there a relationship between infertility and fertilin ß protein distribution?

INTRODUCTION: Fertilin ß is a sperm surface protein that can mediate sperm-egg membrane interaction. This study was conducted to determine whether the expression of fertilin ß after intrauterine insemination (IUI) in donors with normal parameters after standard semen analysis is related to low success rate or failure of fertilization. METHODS: We examined the sperm of 30 male donors who have normal as controls, oligozoospermia, and unexplained infertility as the clinically indication for IUI. Fertilin ß has been labeled with the ADAM2 antibody by indirect immunofluorescence (IF) assay. To evaluate the reproducibility of the test, we selected four sperm samples scale of 0 to +++ according to the distribution of fluorescence label. RESULTS: The results were highly correlated with the corrected total cell fluorescence (CTCF) (Rp=0.9972, P<0.05). We suggest that the relationship between infertility and fertilin ß may be due to the distribution of this protein on the sperm surface. Male partners of couples with unexplained infertility showed a low distribution of fertilin ß by a decrease of the fluorescence signal in the IF labeling (scale of +++ by 7.4±10.32%, P<0.0001, ±SD). DISCUSSION: Abnormal fertilin ß function may be a potential mechanism that could lead to fertilization failure.

Elevated levels of cortisol, brain-derived neurotropic factor and tissue plasminogen activator in male children with autism spectrum disorder.

Several studies demonstrated biological effects of cortisol, brain-derived neurotrophic factor (BDNF) and tissue plasminogen activator (tPA) on human metabolism and central nervous system. Our study investigated the serum levels of tPA along with BDNF and cortisol in children with autism spectrum disorder (ASD). Thirty three male children with ASD ranging in age from 2 to 15 years were selected for the study group and 27 age-matched healthy male children were selected for the control group. The ASD severity was determined by the score on the Autism Behavior Checklist (ABC). The mean cortisol levels for the study group and the control group were 79.1 ± 30.2 ng/ml and 60.0 ± 25.1 ng/ml, respectively. The mean BDNF levels for the study group and the control group were 5.9 ± 2.8 ng/ml and 3.7 ± 1.8 ng/ml, respectively. The mean tPA levels for the study group and the control group were 32.9 ± 18.5 ng/ml and 25.5 ± 15.1 ng/ml, respectively. Cortisol, BDNF and tPA levels were significantly higher in the study group compared to the control group (p < 0.001). There was no statistically significant effect in terms of age, ABC total and subscale scores on serum cortisol, BDNF and tPA levels in the study group (p > 0.05). It may be suggested that elevations may indicate a role in the pathogenesis of ASD or it may be the case that ASD may alter the levels or pathways of these metabolic factors. LAY SUMMARY: The underlying mechanism or a specific metabolic target relevant to autism spectrum disorder (ASD) has not yet been identified. Cortisol, brain-derived neurotrophic factor (BDNF) and tissue plasminogen activator (tPA) have biological effects on neuroplasticity but little is known about the role of cortisol and tPA-BDNF pathway in ASD. In the present study focused on male children with ASD, we have found higher blood levels of cortisol, BDNF and tPA than their healthy peers. This is the first clinical study to evaluate the serum tPA levels along with BDNF and cortisol in ASD. The results suggest that several neurotrophic and other related markers should be born in mind while examining children with ASD.

Catatonia in a child with autistic disorder.

Catatonia is a cluster of motor features that appears in many recognized psychiatric illnesses. It is being increasingly reported in individuals with autism, a disorder characterized by impaired reciprocal social interactions, aberrant language development and restricted behavioral repertoire. However, relatively little is known about the presentation and treatment of catatonia in children with autism. We describe herein an 11-year-old pediatric case with autism who developed catatonic symptoms and was treated effectively with lorazepam. The case reported here differs from previously reported cases in terms of age of onset and the display of all characteristics of catatonia as defined in the Diagnostic and Statistical Manual of Mental Disorders (4th ed) (DSM-IV). In addition, although it was stated that catatonia in autism is commonly associated with impaired language and social passivity, our case is an active verbal individual.

Unilateral peripheral slow flow phenomenon without significant stenosis in lower extremity artery: can primary peripheral slow flow be a new phenomenon?

Peripheral artery disease affects nearly a quarter billion of the world's population, and it is one of the most important causes of decreased quality of life. Primary peripheral slow flow without significant stenosis in peripheral arteries has not been previously reported in the literature. In this case report, we present a slow flow phenomenon that extended from the right external iliac artery to the distal peripheral bed observed during peripheral angiography in a patient who exhibited pain and claudication in the right lower extremity after walking 50 m. Medical treatment provided symptomatic improvement in coronary slow flow and led to a decrease in claudication. Future randomised controlled studies conducted on patients with suspected peripheral slow flow phenomenon would increase our knowledge on both the aetiology and treatment of this condition.

What is the importance of canal-to-diaphysis ratio on osteoporosis-related hip fractures?

OBJECTIVES: This study aims to investigate whether the ratio of the canal-to-diaphysis in femoral subtrochanteric region is helpful in determining risk before hip fracture. PATIENTS AND METHODS: The study group consisted of 116 patients with osteoporotic hip fractures (26 males, 90 females; mean age 77.8 years; range, 61 to 89 years) and the control group consisted of 56 subjects (11 males, 45 females; mean age 75.3 years; range, 60 to 83 years). The canal-to-diaphysis ratio of patients in the study group was measured on plain radiographs. The results of the affected side and intact side were compared. To ensure the interobserver reliability of the measurements and to minimize technical errors, the assessments were performed twice (two weeks apart) by two different orthopedic surgeons. RESULTS: The canal-to-diaphysis ratio was significantly increased in patients with hip fracture compared with the intact side of same patient (p<0.001) and control subjects (p<0.001). According to the results of the receiver operating characteristic analysis, canal-to-diaphysis ratio had a diagnostic value in predicting hip fracture in osteoporosis patients, and the limit value was approximately 0.53 (sensitivity: 81%, specificity: 86%). An index of 0.53 represents a risk of intertrochanteric hip fracture of 89%. CONCLUSION: This method can be easily applied by all physicians as X-ray device is readily accessible with low cost. The risk of hip fracture should be determined, osteoporosis should be evaluated, and treatment should be started in patients with high risk to take the necessary precautions before the fracture develops.

Can distal radius or vertebra fractures due to low-energy trauma be a harbinger of a hip fracture?

OBJECTIVES: This study aims to investigate whether or not low-energy distal radius or vertebra fractures are harbingers of hip fracture. PATIENTS AND METHODS: A total of 142 patients had surgical treatment due to hip fracture in our clinic between February 2013 and January 2017. The patients had low-energy fractures before hip fracture, and they received either medical treatment for osteoporosis or not before hip fracture developed. RESULTS: Of 142 patients, 32 had distal radius, humeral neck, ankle, vertebra fractures and 15 had a second hip fracture. The patients were determined to have most frequently a distal radius and vertebra fracture before hip fracture. The treatment of osteoporosis was determined to be neglected in 58% of 47 patients in total who had a fracture previously. CONCLUSION: Distal radius and vertebra fractures are the harbingers of a potential hip fracture. Physicians, especially orthopedists, who face with these fractures should be careful in terms of osteoporosis.

Is it possible that the pathogenesis of osteoarthritis could start with subchondral trabecular bone loss like osteoporosis?

OBJECTIVES: This study aims to investigate the role of subchondral trabecular bone thickness in the mechanism of knee osteoarthritis and the correlation of osteoarthritis and osteoporosis pathogenesis. PATIENTS AND METHODS: The study included 62 patients (9 males, 53 females; mean age 66.7 years; range, 50 to 84 years) with osteoarthritis. All radiographs were evaluated according to Kellgren and Lawrence classification. The bone mineral density of the patients was measured and bone samples were collected from all patients included in the study during the surgical procedure and investigated pathologically. RESULTS: Osteoarthritis grade and trabecular bone thickness were correlated with each other. Trabecular thickness rate was higher in patients with severe osteoarthritis, whereas trabecular thickness rate was statistically significantly lower than the mean in patients with mild osteoarthritis (p=0.045). CONCLUSION: Trabecular thickness rate was significantly lower in the mild grade of osteoarthritis compared to the severe grade. As the level of osteoarthritis increased, the number of patients with osteoporosis decreased.

Olanzapine-induced Priapism in a Child with Asperger's Syndrome.

BACKGROUND: Priapism is a potentially painful and prolonged erection that occurs in the absence of any stimulation. Olanzapine has been reported to induce priapism in several adult cases with schizophrenia and/or mood disorders but very rarely reported in children. CASE REPORT: 9-year-old male with Asperger's Syndrome (AS) referred to our clinic with the complaints of inattention, hyperactivity and impulsivity. He was diagnosed with attention deficit hyperactivity disorder (ADHD) and given methylphenidate treatment which ameliorated his ADHD symptoms. He started to have severe loss of appetite after methylphenidate treatment so olanzapine 2.5 mg/day was added to cope with severe inappetence. However he experienced priapism after olanzapine and priapism resolved after ceasing the drug. His mother restarted olanzapine because he benefited from olanzapine. But the same episodes occurred soon after olanzapine again and his mother had to stop the medication. CONCLUSION: Because atypical antipsychotics are now widely used in children, unusual side effects such as priapism should be taken into consideration for the differential diagnosis.

Evaluation of executive functions in children and adolescents with familial Mediterranean fever.

The aim of the present study was to investigate neuropsychological test performance in children and adolescents with familial Mediterranean fever (FMF). A total of 88 children and adolescents aged 8 to 17 years were included, 52 with FMF and 36 healthy controls. After the participants were administered the Children Depression Inventory (CDI) and the Screen for Child Anxiety Related Emotional Disorders (SCARED), they completed the battery tests of the Central Nervous System Vital Signs (CNSVS), a neurocognitive test battery, via computer. The battery calculates seven domain scores (Memory, Psychomotor Speed, Processing Speed, Reaction Time, Complex Attention, Executive Function, and Cognitive Flexibility) and a summary score (Neurocognition Index [NCI]). A statistically significant difference between the FMF and control groups was found in six out of seven domains, where the scores of the participants with FMF were found to be significantly lower than those of the control participants (p < .05). Although the mean Reaction Time score of the participants with FMF was found to be lower than that of the control participants, the finding was not statistically significant (p > .05). The mean CDI and SCARED scores of the participants with FMF were found to be significantly higher than those of the control participants (p < .05). Low scores in the Processing Speed and Psychomotor Speed domains of the CNSVS were significantly correlated with higher SCARED scores (r = -.37, p = .01). Impaired cognitive functions should be taken into consideration in children and adolescents with FMF when assessing and managing this population.

Self-Injury and Suicide Attempt in Relation with Trauma and Dissociation among Adolescents with Dissociative and Non-Dissociative Disorders.

OBJECTIVE: To explore the role of trauma and dissociation over self-injurious behaviors (SIB) and suicide attempts (SA) in adolescents. METHODS: A total of 207 adolescents participated in the study. After conducting diagnostic interview, participants were divided into five groups as subjects with dissociative disorders (DD), attention deficit hyperactivity disorder (ADHD), major depressive disorder (MDD) and anxiety disorders (AD), and a control group (CG) without any psychiatric disorder. ADHD, MDD and AD groups were considered as non-dissociative disorders (non-DD group) in the present study. RESULTS: There is no significant difference between groups in terms of number and age of the subjects (p>0.05). Among all participants SIB was reported in 32.2% of females (n=37) and 25% of males (n=23) while SA was reported in 29.6% of females (n=34) and 4.4% of males (n=4). Adolescents with DD were found to experience higher rates of SIB and SA than the other groups. Dissociation was the most important variable contributing to SIB and female gender was the most efficient variable for SA. Total trauma scores were also found to be significantly higher in DD group followed by non-DD and CG respectively. CONCLUSION: SIB and SA are complex behavioral problems which may be associated with many psychiatric factors. However higher level dissociation seems as an important mediating factor, even regardless of psychiatric diagnosis, in the development of SIB and SA. More research is needed to further explore the factors effective over SIB and SA in adolescents.

Assessment of Neurocognitive Functions in Children and Adolescents with Obesity.

Obesity is linked to adverse neurocognitive outcomes including reduced cognitive functioning. We aimed to investigate the differences in neuropsychological test performance of Turkish children and adolescents with obesity and healthy peers. Study includes 147 children and adolescents ranging in age from 8 to 16 years: 92 with obesity and 55 with healthy controls. After the participants were administered the Children's Depression Inventory (CDI) and the Screen for Child Anxiety Related Disorders (SCARED), they completed the battery tests of the Central Nervous System Vital Signs (CNSVS), a neurocognitive test battery, via computer. The battery calculates seven domain scores (Memory, Psychomotor speed, Processing speed, Reaction time, Complex attention, Executive Function, Cognitive flexibility), and a summary score (Neurocognition Index [NCI]). There was a statistically significant difference between the obesity and control groups on all cognitive domains. The mean NCI score of the obesity group was 81.3 ± 10.24 compared to 97.29 ± 4.97 for the control group. The mean NCI score in the obesity group was significantly lower than that of the control group (p < 0.001). The mean scores of other domains of obese patients were also found to be significantly lower than those of the control participants (p < 0.001). The mean SCARED scores of the participants with obesity were found to be significantly higher than those of the control participants (p < 0.05). However, no statistically significant relationship was found between the SCARED and the CNSVS scores. Cognitive dysfunction in children and adolescents with obesity should be taken into consideration when assessing and managing this population.

Localized pigmented villonodular synovitis in a child knee.

Pigmented villonodular synovitis is a benign proliferative tumor of the synovium. It is very rare, and most cases occur in the knee joint. In this article, we report a case of localized pigmented villonodular synovitis in the knee joint of a 14-year-old boy. This condition is rare in the knees of the children. We preferred to remove the tumor with arthrotomy instead of arthroscopy for two reasons: (i) the patient was obese, (ii) we thought that recurrence risk was high after arthrotomy.