An assessment of SLAP type 5 lesions using proton density oblique sagittal imaging in magnetic resonance arthrography.

BACKGROUND: Bankart lesions accompany superior labrum anteroposterior (SLAP) lesions; these are called SLAP type 5. PURPOSE: To compare SLAP type 5 lesions using routine magnetic resonance arthrography (MRA) and thin-slice oblique sagittal proton density (PDW) sequences and correlation operation results. MATERIAL AND METHODS: In total, 181 patients were admitted with shoulder instability. The study was completed with 44 patients. The presence or absence of isolated Bankart and SLAP type 5 lesions in routine MRA and PDW oblique sagittal images were evaluated separately. Absence of rupture scored 0 points, suspected ruptures scored 1 point, and apparent ruptures scored 2 points. The two scores were compared with the shoulder arthroscopy findings. RESULTS: According to the findings in the shoulder arthroscopy, 40 patients had Bankart lesions and 17 patients had accompanying SLAP type 5 lesions. To detect a Bankart lesion, there was no significant difference between routine MRA sequences and PDW oblique sagittal images (P = 0.061). Routine MRA sensitivity was 95%, specificity 25%, positive predictive value (PPV) 92%, negative predictive value (NPV) 33%, while for PDW oblique sagittal images, sensitivity was 75%, specificity 100%, PPV 100%, and NPV 28.5%. In 8/17 type 5 SLAP lesions, routine MRA detected sensitivity 47%, specificity 92.6%, PPV 80%, and NPV 73.5%; in 14/17 SLAP type 5 lesions, PDW oblique sagittal images detected sensitivity 82%, specificity 100%, PPV 100%, and NPV 90% (P = 0.015). CONCLUSION: The PDW oblique sagittal images may play a significant role in assessing the anterior and superior extent of the tears.

The association between the CT severity index and the pulmonary artery area in COVID-19 pneumonia.

BACKGROUND: The pulmonary artery area (PAA) is a valuable non-invasive method for the diagnosis of pulmonary hypertension. PURPOSE: To compare the change in PAA in patients with COVID-19 with the computed tomography (CT) severity index using follow-up imaging. MATERIAL AND METHODS: A total of 81 patients who were followed up and underwent CT assessment more than once at our hospital's pandemic department were evaluated retrospectively. Patients with progression were separated into three groups: progression ranging from mild-to-mild infiltration (Group A, CT severity index of 0-2); progression from mild to severe infiltration (Group B, CT severity index of 0-2 to 3-5); and progression from severe-to-severe infiltration (Group C, CT severity index of 3-5). The PAAs were calculated separately. RESULTS: The mean age was 56 ± 12 years. In terms of those patients showing progression in the CT images, the number of patients in Groups A, B, and C was 29, 40, and 12 in the right lung; 32, 45, and 4 in the left lung; 23, 45, and 13 on both lungs, respectively. There was no significant difference between the main, right, and left PAAs in Group A (P > 0.05). In Group B, there were significant increases in the areas of the main, right, and left PAAs (P < 0.05). There were also significant increases in the areas of the right and main pulmonary arteries in Group C (P < 0.05). CONCLUSION: PAAs increase as disease involvement advances in cases with COVID-19 pneumonia, which is thought to be correlated with progression.

Examination of Facial Convexity and Concavity Values With Reference to the External Acoustic Pore: A Retrospective Study.

The human skull serves as an essential material for facial reconstruction. In particular, the petrous part of the temporal bone is vital due to its compact structure, which can resist mechanical forces. The study aims to give descriptive values to estimate the face shape and produce regression formulas through the external acoustic pore as a reference point. The study was carried out on 3-dimensional computed tomography images, a total of 83 adult images (45 females and 38 males) in the Department of Radiology of Bursa Uludag University Medical Faculty. The distances between the imaginary vertical line passing through the porion and the anthropometric points revealing the facial features were measured for the soft and hard tissue. The vertical distances between the soft and hard tissue landmarks were also measured for both sexes. Measurements were performed with the Image J program, and for the statistical analysis, SPSS 25.0 was used ( P < 0.005). Linear simple regression analysis was used to produce formulas to estimate the soft tissue thickness using hard tissue. Also, discriminant function analysis was performed to determine sex in the presence of an unknown skull. The descriptive values of the variables on the axial and vertical planes and the differences between sexes are given. Also, all formulas make accurate predictions of 90% or more. The authors tried to estimate the anatomical points that roughly reveal the facial features with the regression formulas developed using anthropometric measurements. The authors think that the shape of the face, which is more specific to the individual, can be reached more clearly using mathematical models, and the authors believe that this study will set an example for future studies.

Platelet-hemoglobin ratio predicts amputation in patients with below-knee peripheral arterial disease.

BACKGROUND: Peripheral arterial disease (PAD) causes significant morbidity today. Atherosclerosis is evident in the pathophysiological process in most patients, so PAD has similar risk factors as coronary artery disease. Platelet-Hemoglobin ratio (PHR) has been proven to predict mortality in atherosclerotic heart disease. We aimed to determine the relationship between PHR and below-knee amputation. METHODS: The study is a single-center retrospective study. Platelet count/hemoglobin amount formula was used for PHR. Only PAD patients with below-knee critical extremity ischemia and unsuitable for revascularization were included in the study. RESULTS: 235 patients were included in the study retrospectively. The mean age was 65.7 ± 9.9 years and 175(74.5%) of them were male. In the amputated group, white blood cell, neutrophil, platelet, creatinine, glucose, and PHR were higher (p = .031, p = .045, p = .011, p = .048 p = .018, p = .004, respectively). Only hemoglobin values were lower (p = .003). Multivariable regression analysis showed; age, albumin and PHR were determined as independent risk factors for amputation (Age; OR (95%CI): (1.094(1.040-1.152), p = .001) (Albumin; OR (95% CI): 1.950(1.623-1.799), p = .001) (PHR; OR (95% CI): 1.872(1.246-2.812), p = .003). Receiver operating characteristics analysis performed to determine the optimal cut-off value of PHR for amputation, the optimal value was found 2.08 (65.8% sensitivity, 67.5% specificity, p < .001). CONCLUSIONS: PHR was a good predictor for BKA. Using the PHR, it may be possible to identify high-risk patients for amputation.

The impact of midazolam used in cataract surgery sedation on frontal QRS-T angle.

WHAT IS KNOWN AND OBJECTIVE: Midazolam is one of the most commonly used drugs in procedures requiring sedoanalgesia. It affects the myocardium's ventricular depolarization and repolarization. Previous studies examining the arrhythmogenic effects of midazolam yielded conclusive results. These studies are based on QT and Tp -e distances. The frontal QRS-T angle (f-[QRS-T]a) is a new electro cardiac parameter that shows the heterogeneity of ventricular electrical activity. This study aims to examine the effect of midazolam on f-(QRS- T)a and other depolarization-repolarization parameters in patients who have had cataract surgery. METHODS: The study included 177 patients administered midazolam as a sedoanalgesia during cataract surgery. The sedative effect was evaluated 2-3 minutes after a 0.05 mg/kg dose of midazolam was given. Sedation was assessed again by giving 0.5 mg every 2-3 minutes until the desired level of sedation was achieved. 12-lead electrocardiogram (ECG) recordings of all patients were taken just before and immediately after surgery. ECGs were used to calculate the QT interval, QTc interval, Tp -e interval, Tp -e/QT, Tp -e/ QTc ratios and f-(QRS-T)a. RESULTS AND DISCUSSION: After cataract surgery, f-(QRS-T)a was unchanged compared to presurgery (29.14 ± 4.52 vs. 29.18 ± 5.39, p = 0.852). In addition, no significant change in QT(351.32 ± 21.98 vs. 351.94 ± 22.44, p = 0.091), QTc (384.05 ± 24.52 vs. 385.19 ± 26.12, p = 0.819), Tp -e interval (93.12 ± 9.60 vs. 94.44 ± 8.82, p = 0.179) and Tp -e/QT (0.27 ± 0.02 vs. 0.28 ± 0.03, p = 0.664), Tp -e/ QTc ratios (0.28 ± 0.02 vs. 0.29 ± 0.03, p = 0.655) was observed after surgery when compared to presurgery values. Significant ventricular and supraventricular arrhythmias were not observed in any patient during the operation. WHAT IS NEW AND CONCLUSION: Midazolam did not affect f -(QRS-T) with classical repolarization parameters in patients who underwent cataract surgery, according to this study. Midazolam has been found to be safe for the heart in sedoanalgesia. These results show that sedation with midazolam can be performed without electrocardiogram monitoring.

An association between femoral trochlear morphology and non-contact anterior cruciate ligament total rupture: a retrospective MRI study.

INTRODUCTION: The present study aims to investigate the association of the femoral trochlear morphology with the risk of ACL injury and whether this can be considered an additional risk factor in this clinical table. MATERIALS AND METHODS: This is a retrospective case-control study with 93 patients, 41 patients with ACL total rupture (ACL-TR), and 52 patients without ACL injury who underwent knee magnetic resonance imaging (MRI) between January 2013 and January 2016. The femoral trochlear morphology was evaluated at the proximal and distal levels from the axial knee MRI. The morphological features of the trochlea using sulcus angle, sulcus depth, condylar heights, trochlear sulcus height, percentage of condyles and trochlear sulcus height to transepicondylar width, and lateral and medial trochlear inclination were evaluated. The notch width index was measured on the coronal MR images for notch stenos. RESULTS: ACL-TR group had a significantly higher sulcus angle (p = 0.00-0.001) and lower sulcus depth (p = 0.00-0.002) than the control group at both levels. Femoral trochlea had morphometric differences between genders. NWI was lower in the ACL-TR group than the control group (control 0.273; ACL-TR 0.247), and there was a statistically significant difference (p = 0.00). CONCLUSION: This study was shown that the difference in morphology between the trochlear sulcus of patients with normal and ACL injuries should be taken into account in order to increase awareness of ACL injuries. We observed that mild trochlear dysplasia may cause intercondylar notch stenosis rather than changing the localization of the patella. Studies are needed regarding the effect of trochlear dysplasia on ACL.

Evaluating the Anatomical Traits of Lip on Three-Dimensional Computed Tomography Images.

BACKGROUND: Lips and mouth are the most recognizable parts of the lower face. The morphometry of the facial organs is important for the balance of the face. Besides congenital anomalies occur on the lips, some kinds of deformities might be seen because of trauma or carcinoma. In this respect, lips are in the study of plastic surgery, maxillofacial surgery and orthodontics. Lip morphology also takes an important role in forensic facial reconstruction (facial approximation). MATERIALS AND METHODS: Twenty parameters on the soft tissue and 12 parameters on the hard tissue were measured on three dimensional (3D) computed tomography (CT) images belonging 50 individuals (25 female, mean age 35.40 ±â€Š9.97; 25 male, mean age 34.32 ±â€Š11.06). RESULTS: Statistical significance was observed on 4 parameters measured at soft tissue and 6 parameters measured in hard tissue. Statistical significance was not seen between the measurements taken bilaterally. Fourteen equations were developed in order to estimate the lip morphometry using the morphometric traits of hard tissue. CONCLUSION: We hope that the results of current study will be useful at surgery and forensic sciences.

The impact of volume overload on right heart function in end-stage renal disease patients on hemodialysis.

PURPOSE: The aim of this study was to evaluate the impact of volume overload on echocardiographic parameters used for the assessment of the right ventricle (RV) and right atrium (RA), to determine volume-independent parameters and to noninvasively investigate the physio-mechanics of RV and RA by examining end-stage kidney patients before and after hemodialysis (HD). METHODS: The echocardiographic images were obtained from 67 patients (49.2 ± 17.3 years, 23 f) before and after HD. Changes in echocardiographic parameters with HD were examined. The average ultrafiltrated volume was 3088.1 ± 1103.7 mL. RESULTS: The size of RV and RA and tricuspid annular plane systolic excursion (TAPSE) decreased after HD, whereas myocardial performance index increased. RV fractional area change and iso-volumetric contraction acceleration time remained unchanged. RV global longitudinal strain (GLS) and RV early diastolic strain rate (SR) decreased after HD. Systolic and late diastolic SR of the RV showed no statistically significant difference after HD. Longitudinal strain and SR of RA contraction were not significantly different after HD. The changes in RV GLS (r = .641, P = .027), RV free wall longitudinal strain (r = .643, P < .001), RA reservoir phase strain (r = .60, P = .008), and TAPSE (r = .642, P = .001) significantly correlated with ultrafiltrated volume. CONCLUSION: Two-dimensional speckle tracking echocardiography is an easy and noninvasive tool that could provide additional volume-independent echocardiographic parameters and more information on RA physio-mechanics. This might lead to a better evaluation of the cardiac pathophysiology and hemodynamics of patients. Moreover, providing novel volume-independent parameters for the evaluation of right heart chambers would improve the clinical perspectives of patients.

Risk factors of pneumothorax and chest tube placement after computed tomography-guided core needle biopsy of lung lesions: a single-centre experience with 822 biopsies.

PURPOSE: To determine the risk factors of pneumothorax and chest tube placement after computed tomography-guided core needle lung biopsy (CT-CNB). MATERIAL AND METHODS: Variables that could increase the risk of pneumothorax and chest tube placement were retrospectively analysed in 822 CT-CNBs conducted with 18-gauge non-coaxial CT-CNB in 813 patients (646 men and 167 women; range: 18-90 years; mean: 59.8 years). Predictor variables were age, gender, patient position, severity of pulmonary emphysema, lesion size and localisation, contour characteristics, presence of atelectasis, pleural tag and fissure in the needle-tract, length of the aerated lung parenchyma crossed by the needle, needle entry angle, number of pleural punctures, experience of the operator, and procedure duration. All variables were investigated by ×2 test and logistic regression analysis. RESULTS: The overall incidence of pneumothorax was 15.4% (127/822). Chest tube placement was required for 22.8% (29/127) of pneumothoraxes. The significant independent variables for pneumothorax were lesions smaller than 3 cm (p = 0.009), supine and lateral decubitus position during the procedure (p < 0.001), greater lesion depth (p = 0.001), severity of pulmonary emphysema (p < 0.001), needle path crossing the fissure (p < 0.001), and a path that skips the atelectasis (p < 0.001) or pleural tag (p < 0.001); those for chest tube placement were prone position (p < 0.001), less experienced operator (p = 0.001), severity of pulmonary emphysema (p < 0.001), and greater lesion depth (p = 0.008). CONCLUSIONS: The supine and lateral decubitus position, a needle path that crosses the fissure, and a path that skips the atelectasis or a pleural tag are novel predictors for the development of pneumothorax.

Evaluation of the ossification of the medial clavicle according to the Kellinghaus substage system in identifying the 18-year-old age limit in the estimation of forensic age-is it necessary?

The evaluation of the ossification of the medial clavicular epiphysis being part of an assigned expert approach according to standard plays an important role within civil and criminal proceedings in assessing whether a person has reached her/his 19th or 22nd year of age. Evaluation of the medial clavicular epiphysis with thin-section CT is one of the methods recommended by the Study Group on Forensic Age Diagnostics of the German Association of Forensic Medicine. In this retrospective study, we evaluated the thin-section CT (section thickness of 0.6 and 1 mm) images of 254 patients (146 male, 108 female) with an age range of 13-28 years according to the Kellinghaus substage system. The mean values of female patients were observed to be about 10 months lower for stage 2a than the mean values of the male patients, about 13 months lower for stage 2b, and about 18 months lower for stage 2c. The earliest appearance for stage 3c was at 19 years in both sexes. Our data from this study were consistent with both our previous studies and the data of other studies. We think that stage 3c is important in determining whether a person has reached the age of 18 or not and, therefore, that the Kellinghaus substage system is a requirement in the assessment of forensic age.