Comparison of Computed Tomography Findings between Adult and Pediatric COVID-19 Patients.

PURPOSE: This study aims to compare chest computed tomography (CT) findings between adult and pediatric patients with coronavirus disease-19 (COVID-19) pneumonia. MATERIALS AND METHODS: This study included 30 pediatric patients aged 1 to 17 years and 30 adult patients over 18 years of age with COVID-19 pneumonia confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) who have findings related to COVID-19 on Chest Computed Tomography. The CT findings of adult and pediatric patients were compared with a z-test. RESULTS: Bilateral involvement (p:0.00056), involvement in all five lobes (p<0.00001), and central and peripheral involvement (p:0.01928) were significantly higher in the adult group compared to the pediatric group. In the pediatric group, the frequency of unilateral involvement (p:0.00056), involvement of solitary lobe (p:0.00132), and peripheral involvement (p: 0.01928) were significantly higher than in the adult group. The most common parenchymal finding in adults and pediatric patients was ground-glass opacities (100% and 83%, respectively). Among the parenchymal findings in adults, ground-glass opacities with consolidation (63%) were the second most common finding, followed by air bronchogram (60%) in adults, while in pediatric patients, halo sign (27%) and nodule (27%) were the second most common, followed by the ground-glass opacities with consolidation (23%). CONCLUSION: The CT findings of pediatric COVID-19 patients must be well-known as the course of the disease is usually less severe, and the radiological findings are uncertain when compared with adults.

Masseter Muscle Thickness And Elasticity in Bruxism After Exercise Treatment: A Comparison Trial.

OBJECTIVE: The purpose of this study was to evaluate the effects of Rocabado's 6 × 6 exercises on masseter muscle thickness, muscle elasticity, and pain scores in patients with bruxism. METHODS: A total of 58 participants with bruxism were divided into 2 groups as the exercise group (EG) and control group (CG). A self-care program was applied for the participants in the CG. For those in the EG, in addition to the self-care program, an exercise treatment was performed for 6 days per week for a total of 8 weeks. Using ultrasonography, bilateral masseter muscle thickness and elasticity were assessed before and after treatment. Pain was measured using a visual analog scale. Changes over time within the groups and group-time interactions for continuous variables were assessed using mixed 2-way repeated measures analysis of variance. RESULTS: The improvement in muscle elasticity (P = .015; P = .004) and pain values (P = .049; P = .040) were greater in the EG compared with the CG. There was no significant difference between the 2 groups for masseter muscle thickness (P > .05). CONCLUSION: This study suggests that Rocabado's 6 × 6 exercises are effective in the treatment of muscle elasticity and pain values in participants with bruxism.

Computed tomography findings of COVID-19 in pediatric patients.

BACKGROUND: In this study, we aimed to evaluate the thorax Computed Tomography (CT) findings of pediatric patients diagnosed with coronavirus disease-19 (COVID-19) and to discuss these findings in light of the results of adult patients from the literature. METHODS: The CT scans of pediatric patients (1-18 years old) with a diagnosis of COVID-19 by reverse transcriptase-polymerase chain reaction (RT-PCR) in our hospital between March 2020 and January 2021 were retrospectively reviewed. The scans were interpreted regarding the distribution and localization features, and involvement patterns including ground-glass opacity, consolidation, halo/reversed halo sign, interlobular septal thickening, air bronchograms and bronchiectasis. The frequencies of these findings in pediatric cases in our study were recorded. RESULTS: A total of 95 patients with a mean age of 13±4.6 years were included in this study. Among them, 34 (36%) had lesions associated with COVID-19 on CT scans. Bilateral involvement was detected in 15 (44%) while unilateral in 19 (56%) patients. Eighteen (53%) patients had single lobe involvement. In 16 (47%) patients a solitary lesion was detected and in 18 (53%) multiple lesions were present. Ground-glass opacity appearance was observed in 28 (82%), consolidation in 9 (26%), and ground-glass opacity with consolidation in 8 (24%), halo sign in 9 (26%), reversed halo sign in 2 (6%), interlobular septal thickening (interstitial thickening) in 1 (3%) patients. CONCLUSIONS: As symptoms are relatively milder in children with COVID-19, CT findings are less extensive than in adults. It is essential to know the thorax CT findings that aid in the diagnosis and follow-up of the disease.

The relationship between muscle size, obesity, body fat ratio, pain and disability in individuals with and without nonspecific low back pain.

Patients with nonspecific low back pain (NSLBP) may face motor control problems and health disability barriers during various tasks. However, studies investigating the extent of these disadvantages, and possible associated factors are quite limited in patients with NSLBP. To compare motor control performances and physical assessment domains between patients with NSLBP and asymptomatic controls. Twenty-seven patients with NSBLP and 27 age- and sex-matched asymptomatic controls participated in this cross-sectional study. Ultrasonographic imaging was used to determine abdominal and multifidus muscles thicknesses and adipose tissue rate. Visual analog scale was used to assess LBP severity. Body mass index (BMI) and Oswestry Disability Index (ODI) scores of the participants were physical assessment domains of LBP. BMI values were greater in the NSLBP group compared to the asymptomatic participants. ANCOVA revealed a significant interaction effect regarding external abdominal oblique and multifidus lumborum muscles thickness, and abdominal adipose tissue (p = 0.015; p = 0.001; p = 0.006), respectively in terms of two groups. The thicknesses of these muscles were lesser in the NSLBP group compared with the control group. Similarly, abdominal adipose tissue was higher in the NSLBP group. The stepwise multiple regression analysis demonstrated that the Oswestry Disability Index and abdominal adipose tissue rate were significant and independent factors of the low back pain severity with 73.5% of the variance. The study results indicate that increased disability and fat infiltration are possible determinants influencing pain severity, although further research is required. Examining musculoskeletal properties of lumbar region could provide information about the limitation in patients with NSBLP.

Are Biomechanical Features of the Foot and Ankle Related to Lumbopelvic Motor Control?

BACKGROUND: Any pathomechanical change in the foot or ankle is expected to cause adverse biomechanical effects on the lumbopelvic region. However, no objective data can be found in the literature regarding the effects of musculus transversus abdominis (mTrA) and musculus lumbar multifidus (mLM), which are effective muscles in lumbopelvic motor control, or regarding the extent of their effects. METHODS: Sixty-four healthy young adults were assessed by a physiotherapist (C.K.) experienced in treating feet and a radiologist (Y.D.) specialized in muscular imaging. In the determination of biomechanical properties of the foot, the navicular drop test (NDT), Foot Posture Index (FPI), pedobarographic plantar pressure analysis, and isokinetic strength dynamometer measurements were used in determining the strength of the muscles around the ankle. Ultrasonographic imaging was used to determine mTrA and mLM thicknesses. RESULTS: Significant correlation was found between NDT results and mTrA and mLM thicknesses (P < .05) and between FPI results and mTrA thicknesses (P < .05). As the peak pressure of the foot medial line increased, mTrA and mLM thicknesses decreased (P < .05). Although dorsiflexion muscle strength was also effective, mTrA and mLM thicknesses were found to increase especially as plantarflexion muscle strength increased (P < .05). CONCLUSIONS: These results show that the biomechanical and musculoskeletal properties of the foot-ankle are associated with lumbopelvic stability.

Does Plantar Pressure Distribution Influence the Lumbar Multifidus Muscle Thickness in Asymptomatic Individuals? A Preliminary Study.

BACKGROUND: Atrophy can occur in the lumbar multifidus (LM) muscle quickly as a result of various musculoskeletal problems. Knowing factors influencing muscle thickness of the LM will provide important clues about lumbopelvic stability. OBJECTIVES: Although there are several studies in the literature investigating the adverse effects of foot-ankle postural disorders on the lumbopelvic region, to our knowledge there has been no investigation of plantar pressure distribution (PPD) as a factor influencing muscle thickness of the LM. The aim of this study was to determine whether PPD could affect LM muscle thickness. METHODS: This observational study consisted of 25 asymptomatic individuals. Ultrasonographic imaging was used to determine the thickness of the LM. All participants were subjected to PPD analysis using the Digital Biometry Scanning System and Milletrix software in 9 different plantar pressure zones. The Pearson product-moment correlation coefficients were used to examine the correlations between the LM muscle thickness and other variables. Stepwise multiple linear regression analysis was used to determine the variables with the greatest influence on LM muscle thickness. RESULTS: Peak pressures of medial and lateral zones of the heel were the significant and independent factors influencing static LM thickness, with 39.5% of the variance; moreover, the peak pressures of heel medial and fourth metatarsal bone were the significant and independent factors influencing dynamic LM thickness, with 38.7% of the variance. CONCLUSIONS: Plantar pressure distribution could be an important factor influencing LM thickness, although further research is required. Examining foot-ankle biomechanics may provide information about the stability of the LM.

Traumatismo cerrado menor, gran lesión renal en un paciente pediátrico; curación después de caterización ureteral / Minor blunt trauma, major kidney injury in a pediatric patient; healing after ureteral stenting

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Retrospective evaluation of patients with organizing pneumonia: is cryptogenic organizing pneumonia different from secondary organizing pneumonia?

INTRODUCTION: Organizing pneumonia (OP) is an uncommon clinic opathological situation among lung diseases. If no underlying cause can be detected, it is named as cryptogenic OP (COP). In this study, the etiologic and clinical characteristics of patients diagnosed as OP in our hospital in the last ten years were evaluated retrospectively. It was also aimed to make a comparison between COP and secondary OP patients. MATERIALS AND METHODS: One hundred sixty-five patients diagnosed as OP pathologically in the 10 year period from August 2003 to August 2013 were included into that study. Patients' data were evaluated retrospectively from the medical records. RESULT: One hundred sixty five patients pathologically diagnosed as OP were included. Diagnostic methods were trans-thoracic fine-needle biopsy (TTFNB) in 89 (53.9%) patients, open lung biopsy (lobectomy, wedge resection, segmentectomy) in 52 (31.5%) patients and transbronchial biyopsy (TBB) in 24 (14.5%) patients. One hundred (60.6%) of the patients were defined as COP and 65 (39.4%) as secondary OP. Cough, fatigue and dyspnea were the most common symptoms on admission. We detected OP cases secondary to anthracosis and cyst hydatic besides other well known etiologies. In 61 patients, the main radiologic manifestation was multiple bilateral patchy consolidation typical for OP. In 76 patients focal lesions (solid mass, cavitating mass lesion) and in 6 patients infiltrative opacities were detected radiologically. CONCLUSIONS: There is no difference between properties of OP from clinical, laboratory and radiologic finding sin the criptogenic and seconder form of OP. Although it is not asserted, cyst hidatic and anthracosis could be kept in mind for the list of underlying ethiologies for secondary OP.

Role of Ultrasonography in Detecting the Localisation of the Nasoenteric Tube.

OBJECTIVE: In this study, we aimed to determine the success rate of nasoenteric tube (NET) insertion into the postpyloric area using ultrasonography (USG) and compare with the commonly used method direct abdominal graphy. METHODS: A single anaesthesiologist placed all the NETs. The NET was visualised by two radiologists simultaneously using USG. The localisation of the tube was confirmed using an abdominal graph in all patients. RESULTS: The blind bedside method was used for NET insertion into 34 patients. Eleven of the tubes were detected passing through the postpyloric area using USG. In one case, the NET could not be visualised in the postpyloric area using USG; however, it was detected in the postpyloric area through control abdominal radiography. In 22 patients, NETs were detected in the stomach using control abdominal radiography. The rate of imaging post pyloric using USG was 91.6%. When all cases were considered, catheter localisation was detected accurately using USG by 97% (33 in 34 patients). CONCLUSION: USG is a reliable and practical alternative to radiography, which can be used to detect localisation of the nasogastric tube and NET.

Does a retropulsion prevention device equalize the surgical success of Ho:YAG laser and pneumatic lithotripters for upper ureteral stones? A prospective randomized study.

To establish if a retropulsion prevention device for ureteral stones equalizes surgical success and push-back rates of Ho:YAG laser and pneumatic lithotripters for upper ureteral stones. Patients with upper ureteral stones (n = 267) were treated endoscopically at the Department of Urology between April 2014 and December 2015. Patients were randomly assigned to pneumatic and Ho:YAG laser lithotripters as group-1 and group-2, respectively. Lithotripsy was performed with Stone ConeTM in both groups. The surgical success rate on the first postoperative day was 81.5 % (n = 106) and 90.6 % (n = 116) for group-1 and group-2, respectively, and the difference between the groups was statistically significant (p < 0.05). The relation between stone size and surgical success was statistically significant for both groups (p < 0.01). Surgical success for the stones closer than 2 cm to the UPJ was 23.1 % for the pneumatic group versus 64 % for the laser group (p < 0.01). Lithotripsy time was significantly longer in group-2 (16.48 ± 4.74 min) than group-1 (12.24 ± 3.95 min) (p < 0.01). Ho:YAG laser lithotripsy is more successful than pneumatic lithotripsy for upper ureteral stones and a retropulsion prevention device does not equalize the surgical success of Ho:YAG laser and pneumatic lithotripters for upper ureteral stones on the first postoperative day and one month after surgery. Although the success rate of the first month after surgery is higher in group-2, the difference is not statistically significant.

Are Transitional Vertebra and Spina Bifida Occulta Related with Lumbar Disc Herniation and Clinical Parameters in Young Patients with Chronic Low Back Pain?

OBJECTIVE: Lumbosacral transitional vertebra (LSTV) and spina bifida occulta (SBO) are widespread within the lumbosacral spine. Their connection to lumbar disc herniation (LDH) and/or lower back pain has been debated in the current literature; however, there is no consensus. The purpose of this study is to evaluate the relationship between the frequency of LSTV and SBO with that of LDH among young patients with chronic lower back pain. STUDY DESIGN: Cross-sectional. MATERIALS AND METHODS: A total of 1094 patients with lower back pain, aged between 20 and 40 years, with lower back pain history persisting for longer than 12 weeks were studied. All the patients in the study were evaluated with standard pelvic radiographs and lumbar vertebra magnetic resonance imaging. The severity of pain was measured using the visual analog scale, and the effect of lower back pain on daily life activities was measured using the Oswestry disability index. The patients were separated into two groups: Group 1 consisted of patients without LDH, and Group 2 consisted of patients with LDH. Additionally, these two groups were separated into three subgroups: Non-LSTV-SBO, LSTV, and SBO. RESULTS: It was determined that LSTV frequency was significantly higher (p=0.004) in the lumbar disc herniation group 2. In addition, the existence of LSTV increased the risk of lower back pain (p<0.001, p<0.001) and disability (p<0.001, p<0.001) in young patients with and without LDH or not. However, the presence of SBO did not increase lower back pain (p=0.251, p=0.200) and disability (p=0.134, p=0.161) in both groups. CONCLUSION: A relationship was detected between the frequency of LDH and LSTV in young patients with chronic lower back pain between the ages of 20 and 40 years. Also, the presence of LSTV was found to increase the risk of lower back pain and disability.

Use of FDG PET/CT in Patients with Pancoast Tumors: Does It Add Any Contribution to Patient Management?

PURPOSE: To evaluate any potential value of 2-deoxy-2-[18F] fluoro-D-glucose with positron emission tomography/computerized tomography (FDG PET/CT) in staging of patients with Pancoast tumors and to investigate the relationship between volume-based quantitative PET parameters and prognosis. MATERIALS AND METHODS: The authors retrospectively reviewed data of the 47 patients with Pancoast tumors who underwent initial staging by conventional imaging methods and FDG PET/CT. FDG-PET images were visually and quantitatively evaluated, and metabolic tumor volume (MTV), total lesion glycolysis, and maximum standardized uptake values of primary tumors were calculated. The correlations between quantitative PET parameters and tumor stages, as well as overall survival, were analyzed. RESULTS: By detecting unknown distant metastasis, PET/CT upstaged 21% of patients. The sensitivity and specificity for detection of lymphatic involvement were 100% and 83.75%, respectively. Having surgery (p = 0.01) and being at an early stage (p = 0.004) were the most predictive factors for overall survival. Although there was no significant correlation between quantitative PET parameters and overall survival, MTV was the most powerful discriminator for operability and preoperative staging (p < 0.05). CONCLUSIONS: FDG-PET imaging was found to be a valuable method for an accurate staging in the management of patients with Pancoast tumor. Having surgery and being at an early stage at presentation were found to be significant predictors for survival. Quantitative metabolic parameters may contribute to clarification of operable patient subgroups having an early disease stage with low MTV.

The role of FDG PET/CT in evaluation of mediastinal masses and neurogenic tumors of chest wall.

UNLABELLED: We evaluated the efficiency of FDG PET/CT for the differentiation of malignant from benign mediastinal masses and neurogenic tumors of chest-wall. METHODS: The 88 patients with chest wall-mediastinal masses who underwent examination before operation were retrospectively reviewed. Size, CT density (HU mean) and SUVmax of mediastinal and chest wall lesions were determined. Statistical differences of these parameters were compared between groups by Mann-Whitney U test. Receiver-operating characteristic curve (ROC) analysis with respect to SUVmax was performed to determine the best cutoff value for differentiating benign from malignant masses. RESULTS: The overall sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of PET/CT in detection of malignancy were 90%, 55.17%, 67%, 50.94% and 91.43%, respectively. The SUVmax, HU mean and size were higher in malignant cases (P < 0.05). To distinguish benign and malignant lesions, the cut off value of SUVmax was 4.67. The lesion SUVmax was significantly associated with the lesion size and lesion HU mean values (P < 0.05). The value of SUVmax and HU mean were higher in solid benign lesions than those of cystic benign lesions (P < 0.05). The lesion size was higher in cystic lesions (P = 0.000). The mean SUVmax was significantly higher in invasive thymomas than those of non-invasive forms (P = 0.029). CONCLUSION: FDG PET/CT may be complementary to conventional imaging methods for the evaluation of mediastinal and chest wall masses. PET/CT may reduce unnecessary invasive investigations for diagnosis in patients with nonavid or low avid FDG lesions. However confirmatory tissue sampling is required to confirm PET positive findings for the definite diagnosis.

The Evaluation of FDG PET/CT Scan Findings in Patients with Organizing Pneumonia Mimicking Lung Cancer.

OBJECTIVE: Organizing pneumonia (OP) is a rare lung condition that is characterized by the presence of polypoid tissues due to fibroblastic plugs within respiratory bronchioles, alveolar ducts and sacs. The three main radiologic patterns of OP include typical, solitary-focal and infiltrative forms. The maximum standardized uptake value (SUVmax) on positron emission tomography-computed tomography (PET/CT) may be high in benign conditions such as OP as well as malignant diseases. The aim of our study was to investigate PET-CT characteristics of OP in patients mimicking lung cancer. METHODS: The clinical and radiologic characteristics of 50 patients who were referred to our hospital for PET/CT evaluation due to suspicion of lung malignancy, and who were pathologically diagnosed as OP between 2009 and 2013 were retrospectively reviewed. RESULTS: The mean age of the patients was 58.2 years. Ninety-six percent of patients (48) were male. Radiologic evaluation revealed 27 (54%) focal involvement, 10 (20%) consolidation with air-bronchogram (typical), 1 (2%) infiltrative and 12 (24%) other types of involvement (multiple nodules and cavitary lesions). The mean SUVmax value of the lesions on PET/CT was calculated as 6.5. Mediastinal lymph node involvement (at least one station) was detected in 76% of our study group with a mean SUVmax value of 3.27. CONCLUSION: OP may cause false positive results on PET/CT. However, PET/CT results may be used as a guide for invasive procedures that should be performed when there is suspicion of malignancy.

A case of lemierre syndrome secondary to otitis media and mastoiditis.

Lemierre's syndrome is a rare clinical condition that generally develops secondary to oropharyngeal infection caused by Fusobacterium necrophorum, which is an anaerobic bacteria. A 62-year-old patient with diabetes mellitus presented with internal jugular vein and sigmoid sinus-transverse sinus thrombophlebitis, accompanying otitis media and mastoiditis that developed after an upper airway infection. Interestingly, there were air bubbles in both the internal jugular vein and transverse sinus. Vancomycin and meropenem were started and a right radical mastoidectomy was performed. The patient's clinical picture completely resolved in 14 days. High mortality and morbidity may be prevented with a prompt diagnosis of Lemierre's syndrome.

Integration of 2-deoxy-2-[18F] fluoro-D-glucose PET/CT into clinical management of patients with Wegener's granulomatosis.

OBJECTIVE: Wegener's granulomatosis (WG) is a rare disorder characterized by granulomatous necrotizing vasculitis which mainly affects small- and medium-sized vessels. While the classical triad of involvement is upper and lower respiratory system and glomerulonephritis, WG may involve any organ or system in the body. The aim of our study was to investigate the role of positron emission tomography/computerized tomography (PET/CT) both in the initial evaluation and follow-up of patients with WG. METHODS: We retrospectively evaluated PET/CT data from 13 patients (6 males; 7 females) with a mean age of 45 ± 12.4 years (range 28-63) who underwent either initial evaluation (n = 12) or response evaluation (n = 2) by conventional imaging methods and FDG with PET/CT. PET/CT images were both visually and quantitatively evaluated. The demographic data, clinical and laboratory findings of each patient were also recorded from the hospital files. RESULTS: Lung (n = 13), parapharyngeal space (n = 8), nose (n = 8), and ear (n = 3) were the most common disease sites detected on PET/CT. The entire initial evaluation patients had either solitary or multiple pulmonary nodular/mass lesions with marked increased FDG uptake (mean SUVmax 12 ± 4, range 3.53-19.51) on PET/CT. There was no significant pathological FDG uptake in patients consistent with complete treatment response after appropriate immunosuppressive therapy. PET/CT clearly demonstrated unexpected disease sites besides the respiratory system, with WG involvement except kidneys. Possibly due to physiological urinary excretion of FDG, urine analysis, BUN and creatinine levels were accepted still the best way for diagnosis of renal involvement. CONCLUSION: FDG with PET/CT is a valuable tool in the management of patients with WG for a more accurate clinical evaluation regarding disease extension and treatment response.