Immediate effect of Kinesio taping® on deep cervical flexor endurance: A non-controlled, quasi-experimental pre-post quantitative study.

OBJECTIVE: Whether Kinesio taping® (KT) might change the endurance of the cervical deep flexor muscles. METHODS: Healthy university students were assessed at baseline, immediately after the KT application over the posterior cervical muscles, and at a 24-h follow-up. The clinical assessment of the endurance of the deep cervical flexor muscles using the craniocervical flexion test (CCFT) was performed. RESULTS: Sixty-two students (32 women) with a mean age of 20.4 ± 1.3 years completed the study protocol. Statistically significant pre- to post-taping differences in performance of the craniocervical flexion movement were found between baseline-immediate and baseline-24-h follow-up (p˂0.001). A statistically significant difference in the endurance of the cervical deepflexor muscles was found between baseline-immediate (for stage 2 result and cumulative endurance score), baseline-24-h follow-up (for stage 2result and cumulative endurance score), and immediate-24-h follow-up (for stage 2 result, for cumulative endurance score) p˂0.01. CONCLUSION: Cervical KT increased endurance for the short term.

Ruptured Tentorium Originating Masson Tumor.

Intravascular papillary endothelial hyperplasia (IPEH) also known as Masson's tumor, is a benign, slow growing, vascular lesion which is seen very rarely and only a few cases have been reported intracranially in the literature. It has been reported at many sites, but the posterior fossa involvement is very rare. The preoperative diagnosis is very difficult, as there is no enough cases to achieve a clear understanding about the details of its radiological findings. Differential diagnosis have to be made especially from angiosarcoma and meningioma. It is curable by total surgical removal. In this article we presented the characteristic clinical, radiological, perioperative and pathological findings in a case of IPEH in an unusual location, origin and behavior. To best of our knowledge, we presented the first case of IPEH originating from tentorium.

The rate of intraspinal problems and clinical evaluation of scoliosis: A cross-sectional, descriptive study.

OBJECTIVES: This study aims to define the chronological, angular, and topographic classes in presumed idiopathic scoliosis and to investigate the frequency of generalized joint hypermobility, pain, neurological deficit, ankle deformity, Risser grade, and magnetic resonance imaging (MRI) findings in these patients. PATIENTS AND METHODS: This cross-sectional, descriptive study included a total of 36 patients (11 males, 25 females; mean age 13.4±4.6 years; range, 6 to 24 years) with idiopathic scoliosis between January 2015 and January 2019. Data including age, sex, complaint of pain, generalized joint hypermobility (based on Beighton score), neurological deficit, ankle deformity, and definition of scoliosis were recorded. Chronological, angular, and topographic classification were carried out. The Risser grade and MRI findings were noted. RESULTS: Of all patients, 30 (83.3%) were idiopathic, five (13.9%) were neuromuscular, and one (2.8%) was congenital scoliosis based on MRI findings. Of 13 (36.1%) spine MRI scans, six (46.2%) were intraspinal anomalies, four were syringomyelia (30.8%), one was Chiari type 1 malformation (7.7%), and one was hemivertebrae with diastematomyelia (7.7%). The highest rates of classes according to chronological, angular, and topographical classifications of idiopathic scoliosis were adolescent (17/30, 56.7%), low angular (24/30, 80.0%), and lumbar scoliosis (15/30, 50.0%), respectively. Ten patients (33.3%) complained of pain, while 23 patients (76.7%) had no neurological deficit and seven (23.3%) had hypoesthesia. Seventeen patients (56.7%) had generalized joint hypermobility. CONCLUSION: Idiopathic scoliosis with non-severe spinal deformity may present with intraspinal neural axis abnormalities, even when it is neurologically intact. Based on our study results, it seems to be useful to consider whole spine MRI for the evaluation of thoracic and lumbar scoliosis.

Volumetric assessment of lateral pterygoid muscle in unilateral chewing: a stereologic study.

Unilateral chewing habit is common in dentate populations. It may initiate a hypertrophy process in the lateral pterygoid muscles compared with the nonused sides. We hypothesized that the lateral pterygoid muscles of the affected sides would be larger in volume than those of the nonaffected sides in subjects with unilateral chewing habit. Because analysis of medical images in accordance with the rules of modern stereology enables precise unbiased estimates of muscle volume, and magnetic resonance imaging (MRI) is a criterion standard as an imaging modality for the analysis of muscles because of its excellent soft-tissue resolution, we estimated lateral pterygoid muscle volume both at right and left sides using stereologic techniques (Cavalieri principle) by means of MRI. The MRI-estimated volumes of both the inferior and the superior heads of the lateral pterygoid muscle at the chewing side were significantly greater than the opposite side when compared. This finding may assist in the interpretation of lateral pterygoid muscle and temporomandibular joint-related problems in maxillofacial surgery clinics. This investigation has also demonstrated that systematically sampled MRI slices through the lateral pterygoid muscle can be used to obtain unbiased estimates.

Does quantitative tibial ultrasound predict low bone mineral density defined by dual energy X-ray absorptiometry?

PURPOSE: Efforts for the early detection of bone loss and subsequent fracture risk by quantitative ultrasound (QUS), which is a non-invasive, radiation free, and cheaper method, seem rational to reduce the management costs. We aimed in this study to assess the probable correlation of speed of sound (SOS) values obtained by QUS with bone mineral density (BMD) as measured by the gold standard method, dual energy X-ray absorptiometry (DEXA), and to investigate the diagnostic value of QUS to define low BMD. MATERIALS AND METHODS: One hundred twenty-two postmenopausal women having prior standard DEXA measurements were included in the study. Spine and proximal femur (neck, trochanter and Ward's triangle) BMD were assessed in a standard protocol by DEXA. The middle point of the right tibia was chosen for SOS measurement by tibial QUS. RESULTS: The SOS values were observed to be significantly higher in the normal BMD (t score > -1) group at all measurement sites except for the lumbar region, when compared with the low BMD group (t score < -1). SOS was negatively correlated with age (r= -0.66) and month since menopause (r= -0.57). The sensitivity, specificity, and positive and negative predictive values for QUS t score to diagnose low BMD did not seem to be satisfactory at either of the measurement sites. CONCLUSION: Tibial SOS was correlated weakly with BMD values of femur and lumbar spine as measured by DEXA and its diagnostic value did not seem to be high for discriminating between normal and low BMD, at these sites.

The lumbar roots and pedicles: a morphometric analysis and anatomical features.

The objective of this study was to conduct a morphometric analysis of the lumbar nerve roots and surrounding structures. In this investigation, the lumbar roots were studied in 14 cadavers (70 lumbar vertebrae). Lumbar pedicle heights and widths were measured at every level of the lumbar vertebrae. The largest mean root diameter was 5.6 mm (L5 root) and the smallest 3.5 mm (L1 root). With regard to the root-dura exit angle, the widest was measured at L1 as 26.2+/-1.6 degrees and the narrowest at L5 as 16.3+/-2.4 degrees. The widest lumbar pedicle was measured at L5 as 17.1+/-4.2 mm and the narrowest at L1 as 8.4+/-1.8 mm. The longest lumbar pedicle was measured at L2 as 15.3+/-2.2 mm and the shortest at L4 as 13.8+/-2.3 mm. Quantitative measurements of lumbar root diameters, their exit angles from the dura, and lumbar pedicle heights and widths in anatomical dissection models may help us to gain a deeper understanding of the pathologies of this region and positively influence the success of surgical interventions.

Intrasellar epidermoid cyst presenting as pituitary apoplexy.

We herein present a patient with intrasellar epidermoid cyst presenting as pituitary apoplexy, who was operated upon with a trans-sphenoidal approach. The clinical presentation, radiological and histological differential diagnosis and type of surgical intervention for intrasellar epidermoid cysts are discussed.

Management of spinal synovial cysts.

OBJECTIVE: The report aimed to present the outcome of surgical management of spinal synovial cyst. METHODS: The study was a retrospective review of six patients surgically treated between January 2005 and September 2007. The patients were evaluated in preoperative and postoperative periods. Evaluation was done by questionnaire scoring system. According to this system, categories were; excellent,good, fair, and poor. RESULTS: The duration of follow-up ranged between 3 months and 42 months (mean: 23.3 months; SD: 13.0). Synovial cysts were located in the lumbar spine in 4 of 6 patients. In the other 2 patients, they were in the cervical and thoracal regions. Three patients were female, and three were male. The results of the lumbar group were better than those of the other groups in early period. The findings of the follow-up evaluations were better than those determined in the early postoperative period in all the groups. CONCLUSIONS: Surgery is an effective treatment for spinal synovial cysts, especially for lumbar synovial cysts.

Esophageal carcinoma metastasis to cerebellum: a case report.

Esophageal carcinoma metastatic to the cerebellum and causing cerebellar compression is a rare entity. The authors report on the case of a 54-year-old woman in whom a metastatic cerebellar tumor secondary to esophageal carcinoma was treated. The patient presented with progressively increasing occipital headache. Computerized tomography scanning and magnetic resonance imaging results revealed a mass lesion in the cerebellum. Because of her previous esophageal carcinoma history, metastatic tumor to the cerebellum was assumed, and the patient underwent total resection of the tumor via median suboccipital approach. Histological examination of the specimen showed a metastatic adenocarcinoma of the esophagus. Postoperatively, the patient received 41 Gy radiation as adjuvant therapy. This case represents an addition to the reported literature of such a rare lesion. The diagnosis, treatment, and pathological findings of this case are presented and the pertinent literature is reviewed.

The Efficacy of Flutter® and Active Cycle of Breathing Techniques in Patients with Bronchiectasis: A Prospective, Randomized, Comparative Study.

OBJECTIVES: The objective of the study was to compare the efficacy of an oscillating positive expiratory device and the active cycle of breathing techniques (ACBT) in patients with bronchiectasis. MATERIALS AND METHODS: A home-based study that lasted for 4 weeks was designed to compare the oscillating physiotherapy device Flutter® and the ACBT in 40 patients, who were randomly assigned into two groups containing 20 patients each. The effect of the two methods of physiotherapy on sputum production, pulmonary functions, and the quality of life was compared. RESULTS: The results of the present study indicate that both the methods were associated with a reduced number of patients complaining of cough and fatigue and increased sputum production (p=0.000, p=0.004, and p=0.002, respectively). In addition, statistically significant reductions were determined by the Medical Research Council and Borg Dyspnea scores (p=0.001 and 0.002, respectively). The Flutter® device caused a more significant effect on the perception of dyspnea. Overall, there was an improvement in the physical sub-scale of the Short Form (SF)-36 Quality of Life Questionnaire scores of 36 patients who completed the study (p=0.001). During the physiotherapy period, no changes in pulmonary functions were observed. Exacerbations were recorded in 3 patients in the ACBT group and in 1 patient in the Flutter® group. CONCLUSION: The Flutter® device and ACBT represent effective home-based physiotherapeutic methods. The Flutter® device appears to be more effective with regard to sputum production.

The evaluation of quality of life in fibromyalgia syndrome: a comparison with rheumatoid arthritis by using SF-36 Health Survey.

Musculoskeletal disorders are the most common causes of deterioration in quality of life (QOL). We in this study aimed to assess (1) the impact of fibromyalgia syndrome (FS) on QOL comparing with that of rheumatoid arthritis (RA) patients and control subjects and (2) the impact of these two musculoskeletal disorders on various components of QOL using SF-36 Health Survey. Thirty-five patients with RA, 30 patients with FS, and 30 voluntary control subjects were included in the study. The groups were comparable in terms of demographic characteristics. QOL was evaluated by using Short-Form (SF)-36 Health Survey in all study participants, and Fibromyalgia Impact Questionnaire (FIQ), which is a specific health-status instrument for FS, was used in FS patients. Physical functioning, physical role, social functioning, bodily pain, general health, vitality, emotional role, and mental health scores were significantly lower in RA and FS patients than in control subjects (p<0.05). The between-groups comparisons revealed that FS patients had significantly lower mental health scores than RA patients (49.87 vs 62.51, respectively), (p<0.001). Total FIQ score correlated significantly with physical functioning, physical role, and bodily pain in FS patients. All parameters of SF-36 Health Survey except for social functioning correlated significantly with some of the variables of FIQ. FS has a negative impact on QOL, like RA. Furthermore, mental health was more severely affected in FS patients when compared with RA patients.

Abdominal vascular injury during lumbar disc surgery: report of three cases.

Anterior longitudinal ligament perforation and abdominal vascular injury is one of the most critical complications that may develop during lumbar disc surgery. The vascular injury-related symptoms that warns the surgeon may be late to appear; they usually turn out to be mortal. The hypotension during the operation, tachycardia and pulsatile unstoppable hemorrhage observed in the disc space are the major findings. Urgent detection of this complication and the repair of the vascular injury prevent the case from turning out to be fatal. In the present study, three patients who underwent surgical treatment of abdominal vascular injuries that had developed during lumbar disc surgery, were presented.

Comparing the efficacy of exercise, internal and external shoe modification in pes planus: A clinical and pedobarographic study.

Pes planus is a condition that can cause pain along the innerfoot due to the absence or abnormal depression of the longitudinal arch. There are few studies available that compare therapy modalities used in these patients. In our study, those treated with conservative therapies - internal and external shoe modifications and pes planus exercises - were compared clinically and pedobarographyically. 60 pes planus patients were included in the study. In the first group; internal modification was performed by placing a medial longitudinal arch support inside the shoe. In the second group, external shoe modification was performed using the Thomas heel. In the third group of patients however, only an exercise program was executed. The patients' foot pain levels, functional asssessment, satisfaction and quality of life were recorded. Pedobarography was used in measuring both static and dynamic plantar pressure. Assessments were carried out at baseline and at the end of the first and third months respectively where intra- and inter- group comparisons were performed. Each group was composed of 20 subjects. While improvement in terms of foot pain, foot function index and quality of life was observed in all the study groups (p< 0.05), the most improvement was observed in the group of patients treated with internal modification (p< 0.016). This was followed by the external modification and the exercise groups respectively. No difference was observed between the internal and external modification groups in terms of patient satisfaction. Cross-sectionally; clinical assessments, pedobarographic analysis were correlated. The changes observed after static and dynamic pedobarographic studies were not significantly different between the study groups. At the end of the study it was observed that internal modification yielded the most significant clinical improvement. In the literature, there are limited publications comparing the conservative treatments with each other. In this study we aimed to compare the conservative treatments for flatfoot.

Assessment of regional blood flow in cerebral motor and sensory areas in patients with spinal cord injury.

We assessed the presence and the degree of alteration of the regional blood flow (rCBF) as visualized by Tc-99m HMPAO brain rest SPECT in the sensory motor cortex and subcortical structure in spinal cord injury (SCI) patients, who suffered from various levels of motor and sensory function loss. Twenty-two patients (mean age: 42.1+/-13.4 years, 18 M, 4 F) and 11 control subjects (mean age: 32.2+/-6.4 years, 8 M, 3 F) participated in this study. The spinal cord injury group was consisted of 2 groups (14 paraplegic and 8 tetraplegic patients). The corticocortical rCBF ratios were calculated by using region of interests obtained from 34 cortical areas on coronal slices. Significantly reduced rCBF were measured from 11 cortical areas in tetraplegic patients and 11 cortical areas in paraplegic patients. Some of these areas were different in each group. In the tetraplegic group, significant reduction was observed in the following rCBF areas: left anterior cingulate gyrus, left medial supplementary motor area, bilateral front and back aspects of posterior cingulate gyrus, right lateral primary motor area, right medial primary sensory area, bilateral putamen, and right cerebellum. In the paraplegic group, reduced rCBF areas were as follows: bilateral anterior cingulate gyrus, right lateral supplementary motor area, left front aspect of posterior cingulate gyrus, left lateral primary motor area, bilateral back aspects of posterior cingulate gyrus, right medial primary sensory area, left lateral primary sensory area and bilateral putamen. In conclusion, in some of the movement-cortical and subcortical areas having significantly reduced blood flow in SCI may be helpful to demonstrate the disrupted areas of rCBF by SPECT. We believe that it may be useful if these findings should be considered during the evaluations related to the reorganization in SCI cases.

Morphometric analysis of the roots and neural foramina of the lumbar vertebrae.

BACKGROUND: There have been few anatomic studies on the foramina and roots of the lumbar region, and those available in human specimens are usually based on computed tomography and magnetic resonance imaging methods. METHODS: Using the recent breakthroughs in microscopic anatomic dissections, the roots and vertebral foramina of the lumbar region were examined in 15 cadavers. Morphometric analysis of the roots and vertebral foramina of 80 lumbar vertebral objects was conducted. RESULTS: The transverse and sagittal diameters of the lumbar intervertebral foramina were measured at each vertebral level. The median diameter of the lumbar neural foramina was 8.8 +/- 1.7 mm for the transverse and 19.4 +/- 2.7 mm for the sagittal planes. The widest median diameter of roots was 3.9 mm in the L4 root, and the narrowest was 3.3 mm in the L1 root. CONCLUSION: Quantitative measurements of the diameters of the neural foramina and roots of the lumbar region in anatomic dissection models may provide a deeper understanding about the pathologies of this region and influence the success of surgical interventions.

Cervical foraminal area and intervertebral height changes after titanium ring cage placement: preliminary results.

OBJECTIVE: To investigate the effect of titanium ring cage implantation on cervical foraminal area and intervertebral height. METHODS: Twenty-two patients with single level cervical disc herniation were enrolled in this study. All patients underwent a standard anterior cervical discectomy followed by titanium ring cage implantation. Radiographs were used for evaluation of the cervical foraminal area and intervertebral height in the pre- and postoperative periods. RESULTS: Mean intervertebral heights were 0.7 +/- 0.1 cm (preoperative), 1.1 +/- 0.2 cm (early postoperative) and 0.9 +/- 0.2 (final measurement). Increase in intervertebral height at final follow-up was 0.2+/-0.1 cm (22.6+/-8.5%). Mean cervical foraminal areas were 0.4+/-0.1 cm2 (preoperative), 0.5 +/- 0.2 cm2 (early postoperative) and 0.5 +/- 0.1 cm2 (final measurement). Increase in cervical foraminal area at the final follow-up was 0.1 +/- 0.1 cm2. CONCLUSION: Our study demonstrates that cervical intervertebral height and cervical foraminal area significantly increased after cervical ring cage placement but subsidence during the follow-up period negatively affects foraminal area. However, overall, there was a relative increase of foraminal area and intervertebral height when compared with preoperative values. Long-term follow-up is required to further assess the subsidence rate.

Primary intradural extramedullary hydatid cyst.

Spinal hydatid cysts account for 1% of all cases of hydatid disease; primary intradural hydatid cysts are uncommon. We present a case of pathologically confirmed intradural spinal cyst hydatid in an otherwise healthy patient who showed no other evidence of systemic hydatid cyst disease. The patient presented with back pain, paraparesis, and weakness. An intradural extramedullary cystic lesion was identified with magnetic resonance imaging and was shown to be a hydatid cyst by histopathologic examination after surgical removal. To our knowledge, this is the 25th case of hydatid cyst at an intradural extramedullary location reported in the literature.

Extra-axial ependymoma of posterior fossa extending to the Meckel's cave.

An extra-axial ependymoma extending from the left cerebellopontine corner to the Meckel's cave is reported. This lesion's clinical, radiological, and histological characteristics are presented. This tumor's infrequent extra-axial location, extension to the Meckel's cave and possible origin are discussed.

Olfactory groove meningiomas.

Meningiomas originating from the olfactory groove account for approximately 10% of all intracranial meningiomas. They represent only 2% of all intracranial tumors. We present the diagnostic, clinical and pathological features of olfactory groove meningiomas and describe our surgical results and complications in a series of 25 patients. In 19 patients, surgery was via a bifrontal approach, and in the remaining six a pterional approach was used.