USG-guided injection of corticosteroid for lateral epicondylitis does not improve clinical outcomes: a prospective randomised study.

BACKGROUND: Corticosteroid injection used to be the treatment of choice for lateral epicondylitis. Most injections are performed blindly. In the blinded technique, it could be difficult to determine the exact pathological localisation. The purpose of this single-blinded, randomised controlled clinical study was to compare the clinical therapeutic effects of blinded and USG-guided corticosteroid injection therapy in lateral epicondylitis. PATIENTS AND METHODS: Forty patients with chronic lateral epicondylitis were included in this clinical trial. The patients were randomly allocated to blinded group or USG-guided injection group according to a computer-generated randomisation list. All blinded injections were administered by an orthopaedic surgeon and all ultrasound-guided injections were made by a radiologist experienced in this technique. All patients were injected under aseptic conditions using 40 mg/2 mL methylprednisolone acetate. The outcomes of both treatments were assessed by an independent assessor at pre-injection, then at 6-week and 3- and 6-month follow-up assessments. The assessor evaluated the q-DASH, VAS, and grip strength scores. RESULTS: No statistically significant difference was determined between the groups in respect of the Q-DASH and grip strength scores preoperatively and at 6 weeks and 3 and 6 months post-injection. No statistically significant difference was determined between the groups in respect of the VAS scores preoperatively and at 6 weeks and 6 months. No systemic or local complications were reported during the treatment. CONCLUSION: There was no statistically significant difference compared to the blinded injection technique, and the mean score differences between the groups are of no clinical relevance.

Is there a relationship between talar osteochondral lesions and foot angles?

PURPOSE: We aimed to evaluate the relationship between talar osteochondral defects (OCDs) and foot angles in this study. MATERIALS AND METHODS: We performed a retrospective study that included 25 patients with talar OCD and 29 patients without OCD who underwent magnetic resonance imaging in our department between September 2013 and January 2015. We retrospectively measured the foot angles (Bohler's angle, lateral talocalcaneal angle and calcaneal inclination angle) on ankle radiographs in both groups. RESULTS: Bohler's angle showed no significant differences between the patients (range 20.50°-48.10°, mean 33.40° ± 6.09°) and the control group (range18.80°-42.40°, mean 31.95° ± 4.21°) (p = 0.397). Calcaneal inclination angle showed no significant differences between the patients (range 3°-29.2°, mean 20.55° ± 6.73°) and the control group (range 10.20°-29.80° mean 20.47° ± 4.21°) (p = 0.956). However, talocalcaneal angle was significantly higher in the patients (range 27.80°-44.80°, median 39.50° ± 6.18°) compared with the control group (range 22.60°-40.50°, median 34.10° ± 4.26°) (p = 0.032). CONCLUSION: There is an association between lateral talocalcaneal angle and non-traumatic talar OCD.

Factors affecting the course of body and kidney growth in infants with urolithiasis: A critical long-term evaluation.

OBJECTIVE: To investigate the possible effects of dietary, patient and stone related factors on the clinical course of the stone disease as well as the body and renal growth status of the infants. PATIENTS AND METHODS: A total of 50 children with an history of stone disease during infancy period were studied. Patient (anatomical abnormalities, urinary tract infection - UTI, associated morbidities), stone (obstruction, UTI and required interventions) and lastly dietary (duration of sole breast feeding, formula feeding) related factors which may affect the clinical course of the disease were all evaluated for their effects on the body and renal growth during long-term follow-up. RESULTS: Mean age of the children was 2.40 ± 2.65 years. Our findings demonstrated that infants receiving longer period of breast feeding without formula addition seemed to have a higher rate of normal growth percentile values when compared with the other children. Again, higher frequency of UTI and stone attacks affected the growth status of the infants in a remarkable manner than the other cases. Our findings also demonstrated that thorough a close follow-up and appropriately taken measures; the possible growth retardation as well as renal growth problems could be avoided in children beginning to suffer from stone disease during infancy period. CONCLUSIONS: Duration of breast feeding, frequency of UTI, number of stone attacks and stone removal procedures are crucial factors for the clinical course of stone disease in infants that may affect the body as well as kidney growth during long-term follow-up.

Diffusion-weighted imaging of normal appearing corticospinal tracts in patients with multiple sclerosis.

Aim To determine if there are differences in ADC values between normal appearing corticospinal tracks in patients with MS compared to ADC values in controls. Material and methods The study population comprised 62 consecutive MS patients (36 women and 26 men; mean age 36.45±8.63 years). 50 control subjects with no neurological disabilities or intracranial were included the study (32 women and 18 men; mean age 40.18±12.25 years). All ADC maps were independently evaluated by two experienced radiologists. ROI of approximately 15-18 mm2 in capsula interna and 10-12 mm2 in mesencephalon were placed bilaterally for measurement of ADC values. Three circular ROIs were placed-one each side for internal capsule-and 6 total ROIs from right and left internal capsule were averaged for each patient. Mesencephelon ADC measurements were performed similarly. Result The mean ADC values of the left internal capsule in MS patients were significiantly lower than the control group (p:0.002). No statistically significant difference was found between the MS patients and control group mean ADC values of the right internal capsule (p>0.05). The mean ADC values of the right and left mesencephalon in MS patients were significiantly lower than the control group (respectively; p:0.031, p<0.001). The mean ADC values of the left internal capsule were significiantly lower than the right internal capsule in MS patients (p<0.001). The mean ADC values of the left mesencephalon were significiantly lower than the right mesencephalon in MS patients (p<0.001). Conclusion The mean ADC values of the normal-appearing corticospinal tract in MS patients were significantly lower than the control group except for the right internal capsule.

ISCHIOFEMORAL IMPINGEMENT: ASSESSMENT OF MRI FINDINGS AND THEIR RELIABILITY.

OBJECTIVE: To evaluate the Magnetic Resonance Imaging (MRI) findings and their validity in patients with ischiofemoral impingement syndrome (IFI) . METHODS: We retrospectively analyzed 55 hips. MRI findings of 30 hips were consistent with IFI syndrome. Twenty five hips had no MRI findings consistent with IFI syndrome. We compared the ischiofemoral space (IFS), quadratus femoris space (QFS), ischial angle (IA) and femoral neck angle (FNA) between the age and gender matched groups. We also analyzed edema, fatty replacement and partial or total rupture of quadratus femoris muscle. Mann Whitney U test was used to compare the data. RESULTS: We observed atrophy in eight, fatty replacement also in eight and edema in all of the quadratus femoris muscle. QFS (p<0.001) and IFS (p<0.001) were significantly lower in patients as compared to the control group. IA (p=0.012) and FNA (p=0.010) values were significantly higher in patients compared with the control group. CONCLUSION: MRI findings of IFI include narrowing of QFS and IFS and increase in IA and FNA. This condition should be kept in mind for patients with hip pain. Level of Evidence III, Retrospective Study.

The relationship of ADC values of renal parenchyma with CKD stage and serum creatinine levels.

PURPOSE: To evaluate the relationship of apparent diffusion coefficient (ADC) values of renal parenchyma with chronic kidney disease (CKD) stage and serum creatinine levels. MATERIALS AND METHODS: One hundred and ten patients who had undergone magnetic resonance imaging of the upper abdomen for different reasons were retrospectively studied. A region of interest (ROI) was placed on the renal parenchyma for measurement of ADC values of both kidneys, without any preference for cortex or medulla. Three circular ROIs were placed-one each in the upper pole, interpolar region and lower pole of both kidneys. The mean ADC values were recorded for each patient and the relationship between ADC values and stage of CKD and serum creatinine levels were evaluated. RESULTS: Statistically significant difference was determined between the ADC values of the cases according to CKD stages (p < 0.001). Paired comparisons performed to determine the group that caused the difference revealed that median ADC values of healthy subjects who formed the control group was statistically significantly higher than that of the cases with stage 3, stage 4 and stage 5 CKD (p: 0.008; p: 0.008; and p: 0.002, respectively). Sensitivity and specificity were found to be 75.44% and 69.81%, respectively in detecting stage 3, stage 4 and stage 5 CKD among the cases with ADC values of 1151 and lower. CONCLUSION: ADC values can play a role in the evaluation of renal dysfunction. However, population-and protocol-based cut-off ADC values are needed to identify renal dysfunction and to distinguish between different stages of CKD.

Histopathological evaluation of five unusual gingival enlargement cases.

Gingival fibromatosis represents the fibrous hyperplasia of the gingival tissue. Clinical examination reveals enlargement of buccal and palatal gingival tissue. Many forms of gingival fibromatosis are of unknown etiology and termed as idiopathic gingival fibromatosis. However, several authors use various terms such as gingivomatosis and elephantiasis to describe these lesions. Our aim in this case report is to present five patients (one female, four males) with unusual clinical forms of gingival hyperplasia and to discuss the histopathological and clinical features in comparison to similar enlargements. Clinical examinations did not reveal increased periodontal pocket depths, besides plaque and gingival index scores were found to be in normal range. All of the patients were systemically healthy and were not subject to medications, which could lead to gingival hyperplasia. Additionally, clinical appearance of the lesions did not show any signs of trauma. Excisional biopsies were performed in all cases. The pathological examinations of the specimens demonstrated fibroconnective tissue characteristics, which were in accordance with the clinical appearance of all patients. Lesions healed successfully without sequelae or infection, and no recurrence was observed after 1-year follow-up.

Endobronchial recurrence of non-Hodgkin's lymphoma mimicking foreign body aspiration.

A 2-year-old patient with a history of non-Hodgkin's lymphoma (NHL) was presented to our hospital with the complaint of shortness of breath and wheezing. Posteroanterior chest radiograph revealed hyperlucency and hyperexpansion of the right hemithorax. We performed computed tomography (CT) because of a suspicion of foreign body aspiration. CT revealed right main bronchus occlusion by a hypodense lesion. Bronchoscopy revealed a mass lesion in the right main bronchus which was histopathologically diagnosed as NHL. Only a few cases of endobronchial recurrence of lymphoma have been reported in the current literature, but there is no reported case in a pediatric patient.

The role of lipoid proteinosis in gingival hypertrophy.

Hyalinosis cutis et mucosae (lipoid proteinosis, Urbach-Wiethe disease) is a rare syndrome with autosomal recessive inheritance. The disease is characterized by diffuse deposition of a hyalinelike substance in the dermis, submucosal connective tissue, and various internal organs. In this study, the patient demonstrated classic signs and symptoms of lipoid proteinosis except for gingival infiltration. Gingival infiltration is still an unexplainable feature of this disease. In the context of this case, the diagnostic significance of the microscopic findings of the gingival tissues and the possible factors playing a role in gingival hypertrophy, are discussed.

Concomitant meningioma and glioma within the same optic nerve in neurofibromatosis type 1.

A patient with neurofibromatosis type 1 and the rare finding of concomitant meningioma and optic pathway glioma within the same optic nerve is presented. A 4-year-old boy was admitted to our hospital with right-sided proptosis. He also had numerous café-au-lait macules and axillary freckling on physical exam. According to National Institutes of Health (NIH) criteria, he met the diagnostic criteria for neurofibromatosis type 1. On magnetic resonance imaging (MRI), a mass originating from the right optic nerve sheath with normal appearance of the optic nerve was observed, which was consistent with optic nerve sheath meningioma. Another mass lesion was observed in the prechiasmatic region of the same optic nerve, which was consistent with optic nerve glioma. Two different types of optic pathway tumors in the same optic nerve is an extraordinary case. It is important to recognize imaging findings of these tumors and make correct diagnosis.

Characterization of malignant thrombus in an invasive thymoma with intravascular growth.

We report an unusual case of an invasive thymoma with a thrombus in the right atrium and describe the radiological findings consistent with the malignant nature of the thrombus. The thrombus showed significant enhancement on computerized tomography images similar to the tumoral mass. On magnetic resonance imaging, both the tumor and the thrombus have heterogeneously high signal intensities on T2-weighted images. On diffusion-weighted images they both exhibit high signal intensity and low apparent diffusion coefficient (ADC) values which support the malignant nature of the thrombus and the mass.

A minimal invasive surgical alternative to aberrant systemic arterial supply: Coil embolization.

We present the case of a 20-year-old man with hemoptysis for 3 years. Chest radiography revealed increased pulmonary vascular opacities in the left lower lung field. Computed tomography showed an anomalous systemic artery arising from descending aorta supplying the basal segments of the left lower lobe. Bronchial tree was normal. Pulmonary artery angiogram revealed a hypoplastic inferior lobar branch of the left pulmonary artery. There was no direct communication between anomalous artery and pulmonary veins. We diagnosed our case as aortopulmonary collateral with normal lung parenchyma. Coil embolization of the anomalous systemic artery was performed. The patient survived well without evidence of hemoptysis for 18 months after coil embolization.

Ischiofemoral impingement: assessment of mri findings and their reliability

ABSTRACT Objective: To evaluate the Magnetic Resonance Imaging (MRI) findings and their validity in patients with ischiofemoral impingement syndrome (IFI) . Methods: We retrospectively analyzed 55 hips. MRI findings of 30 hips were consistent with IFI syndrome. Twenty five hips had no MRI findings consistent with IFI syndrome. We compared the ischiofemoral space (IFS), quadratus femoris space (QFS), ischial angle (IA) and femoral neck angle (FNA) between the age and gender matched groups. We also analyzed edema, fatty replacement and partial or total rupture of quadratus femoris muscle. Mann Whitney U test was used to compare the data. Results: We observed atrophy in eight, fatty replacement also in eight and edema in all of the quadratus femoris muscle. QFS (p<0.001) and IFS (p<0.001) were significantly lower in patients as compared to the control group. IA (p=0.012) and FNA (p=0.010) values were significantly higher in patients compared with the control group. Conclusion: MRI findings of IFI include narrowing of QFS and IFS and increase in IA and FNA. This condition should be kept in mind for patients with hip pain. Level of Evidence III, Retrospective Study.