Poor Accuracy of Clinical Diagnosis in Pes Anserine Tendinitis Bursitis Syndrome.

OBJECTIVES: To investigate the characteristics of the patients who are clinically diagnosed with pes anserine tendinitis bursitis syndrome (PATBS), and to determine the sensitivity and specificity of clinical diagnose based on magnetic resonance imaging (MRI). METHODS: Included in this cross-sectional clinical study were 156 patients who were evaluated based on the clinical presence or absence of PATBS. All patients underwent Q-angle measurement, knee osteoarthritis (OA) grading according to the Kellgren-Lawrence classification, and medial joint space measurement, and their cartilage thickness, and any periarticular and intraarticular knee pathologies were recorded from an assessment of knee MRIs. RESULTS: Of the total, 64 cases (41%) were diagnosed clinically with PATBS and 92 (59%) were not. There was no difference in the Q angles of the two groups (p > 0.05), while the medial joint spaces were significantly lower in the PATBS patients (p < 0.05). There were no significant differences between the two groups in an MRI assessment of meniscus and ligament lesions, chondromalacia patella, cyst, bursitis, effusion and synovial pathologies (p > 0.05). The sensitivity and specificity of the PATBS clinical diagnoses relative to the MRI findings were determined as 41.2% and 59.5%, respectively. CONCLUSION: The medial joint space was found to be significantly lower in patients with PATBS, while there was no difference in any other knee pathologies between the two groups. The sensitivity and specificity of a PATBS clinical diagnosis were found to be low, and so it was concluded that clinical PATBS diagnoses may be inaccurate, particularly in the presence of such invasive therapies as injection, and that diagnoses based on imaging methods would be more accurate.

Low back pain in children and adolescents: Real life experience of 106 patients.

OBJECTIVE: To analyze the demographic data, etiologies and risk factors of 106 children and adolescents with low back pain (LBP) who applied to our clinic. METHODS: The medical records of patients with low back pain under 18 presenting to our clinic in 2014-2018 were examined retrospectively. Patients' demographic data, physical examination findings, laboratory and imaging results, and risk factors for low back pain were evaluated; diagnosis and treatment modalities were recorded. RESULTS: In this study, 106 children and adolescents 8-17 (mean 14.24±2.33) years, 55 girls (51.8%) and 51 boys (48.1%) were included. Sixty-two patients (58.4%) were diagnosed with non-specific low back pain, 24 (22.6%) with lumbar disc herniation, six (5.6%) with inflammatory low back pain, five (4.7%) with spondylolysis (with accompanying listhesis in two), five (4.7%) with scoliosis, and four (3.7%) with Scheuermann Disease. Three patients were operated and another patient underwent an algological intervention for persistent pain. Six patients diagnosed as spondyloarthropathy were referred to the pediatric rheumatology department. Pain in the remaining cases was brought under control using conservative methods in a combination of medical treatment, rest and physiotherapy. CONCLUSION: Low back pain is a frequent complaint in the child-adolescent age group. The causes of low back pain are as diverse as adults in this age group. The contrary common belief that severe problems, such as malignancy are common, mechanical reasons as the most common cause of low back pain.

Effect of visceral fat tissue on superior mesenteric artery configuration: Is it superior to BMI?

BACKGROUND/AIMS: To determine the effect of visceral fat volume measured via computed tomography (CT) images of umbilical slices on superior mesenteric artery (SMA) configuration, as compared with body mass index (BMI). In addition, this study aims to determine the effect of lumbar lordosis angle (LLA) on SMA configuration. MATERIALS AND METHODS: The study included 310 patients who underwent abdominal CT. On CT images, the aortomesenteric angle (AMA), the distance between SMA and aorta at three levels, and LLA were measured. Visceral fat volume was measured using three consecutive images obtained at the level of the umbilicus. The relationship among AMA, and distances measured between SMA and aorta, and visceral fat tissue volume were determined. The effect of LLA on AMA and distances measured between SMA and aorta was analyzed. RESULTS: There was a significant positive correlation between visceral fat volume, and patient age, AMA, distances between SMA and aorta, LLA, and BMI (p<0.001). There were not any significant differences in AMA, distances between SMA and aorta, BMI, or visceral fat volume between the patients with an LLA of 20°-45° and those with an LLA >45° (p>0.05). There was a significant positive correlation between BMI, and AMA, distances between SMA and aorta (p<0.001). There was a significant positive correlation between visceral fat volume, and AMA, distances between SMA and aorta (p<0.001). CONCLUSION: Visceral fat tissue volume is more valuable than BMI for evaluating the SMA configuration.

The Effect of Lumbosacral Transitional Vertebrae (LSTV) on Paraspinal Muscle Volume in Patients with Low Back Pain.

RATIONALE AND OBJECTIVES: To determine if psoas, multifidus, and erector spina muscle volume at intervertebral disc levels differ in patients with lumbosacral transitional vertebrae (LSTV) and low back pain (LBP), and in LBP patients without LSTV. MATERIALS AND METHODS: This retrospective study included 101 patients that underwent lumbar spinal MRI due to LBP. The patients were divided into two groups according to the presence of LSTV, as those with LSTV (LSTV group) and those without LSTV (control group). Those in the LSTV group were classified according to Castellvi classification, and whether or not LSTV was bilateral or unilateral. The lumbar lordosis angle was measured using sagittal T2-weighted MR images. Axial T2-weighted images were used to bilaterally measure psoas, multifidus, and erector spina muscle volume at intervertebral disc levels. RESULTS: Among the 101 participants, 33 were male (32.7%) and 68 were female (67.3%). Left multifidus muscle volume at the L4-5 level was significantly lower in the LSTV group than in the control group (p = 0.033). Right and left erector spina muscle volume at the L5-S1 level was significantly lower in the LSTV group than in the control group (right side: p = 0.010; left side: p = 0.003). The mean lumbar lordosis angle was 47.54 ± 12.69° in the LSTV group, versus 35.34 ± 11.53° in the control group (p < 0.001). There were not any significant differences in psoas, multifidus, or erector spina muscle volume between the patients with unilateral and bilateral LSTV (p > 0.05). CONCLUSION: The present findings indicate that paraspinal muscle volume can be used to understand LSTV symptomatology.

Comparison of a 4-Day versus 2-Day Low Fiber Diet Regimen in Barium Tagging CT Colonography in Incomplete Colonoscopy Patients.

Our aim was to compare the amount of residual feces, residual fluid, the tagging quality, and patient compliance using 4-day versus 2-day low fiber diet regimen in barium tagging CT colonography in incomplete colonoscopy patients. Methods. A total of 101 patients who underwent CT colonography were assigned to 2-day diet group (n = 56) and 4-day diet group (n = 45). Fecal tagging was achieved with barium sulphate while bisacodyl and sennoside B were used for bowel preparation. Residual solid stool was divided into two groups measuring <6 mm and ≥6 mm. We graded the residual fluid, tagging quality for solid stool, and fluid per bowel segment. We performed a questionnaire to assess patient compliance. Results. 604 bowel segments were evaluated. There was no significant difference between 2-day and 4-day diet groups with respect to residual solid stool, residual fluid, tagging quality for stool, and fluid observed in fecal tag CT colonography (P > 0.05). The prevalence of moderate discomfort was significantly higher in 4-day group (P < 0.001). Conclusion. Our study shows that 2-day limited bowel preparation regimen for fecal tag CT colonography is a safe and reasonable technique to evaluate the entire colon, particularly in incomplete conventional colonoscopy patients.