Does skyline view prevent extensor tendon pathologies during volar plating of distal radius? An ultrasonographic evaluation.

OBJECTIVES: This study aims to compare extensor tendon complications of volar plating in distal radius fractures between skyline and lateral views by using postoperative ultrasonography (USG). PATIENTS AND METHODS: Between January 2019 and February 2020, a total of 82 distal radius fractures of 79 patients (39 males, 43 females; median age: 56±12.9 years; range, 23 to 79 years) who were operated with distal four-hole plates and had a follow-up period of at least three months were retrospectively analyzed. During distal radius locking plating, standard lateral fluoroscopic view was used in 36 distal radius fractures and skyline view in addition to lateral view was used in 46 cases. A median of five months later, the protruding screws and extensor compartments were evaluated with USG. The number of screws with dorsal penetration, extent of penetration, and extensor tendon complications were compared between skyline and lateral view groups. RESULTS: In the skyline view group, the rate of dorsal screw penetration was significantly lower than that of the lateral view group (7.3% vs. 14.7%, respectively; p<0.05). Additionally, the rate of extensor tenosynovitis was lower in the skyline view group than in the lateral view group (15% vs. 39%, respectively; p<0.05). No significant difference was seen in the extent of penetration between the groups (1.4 vs. 1.65 mm, respectively; p=0.089). The second compartment had the highest risk for dorsal screw penetration. One case of tendon rupture in the third compartment occurred in the lateral view group. CONCLUSION: The skyline view seems to be an effective method to prevent extensor tendon complications caused by protruding screws.

Benign incidental lesion of the calcaneus: the calcaneal vascular remnant.

BACKGROUND: The calcaneal vascular remnant, first described by Fleming et al. in 2005, is a benign intramedullary lesion of the calcaneus with a vascular origin. PURPOSE: To determine the prevalence and magnetic resonance imaging (MRI) characteristics of incidental calcaneal vascular remnant on routine ankle MRI. MATERIAL AND METHODS: We retrospectively reviewed 457 ankle MRI scans for the presence of calcaneal vascular remnant. MRI was considered positive when a focal cyst-like area was seen on a T2-weighted sequence, and a low signal intensity was identified on a T1-weighted image beneath the calcaneal sulcus. Patients with calcaneal vascular remnants were further evaluated for age, gender, right or left foot location, size, and lesion characteristics. RESULTS: The prevalence of incidental calcaneal vascular remnant was 21.7% on our consecutive ankle MR examinations. The average lesion size was 5.5 mm. No statistically significant difference was noted in the frequency of lesion detection between gender, age, and side of the lesions (P > 0.05). Multilobulated lesions were detected predominantly in women (P = 0.013) and classic type lesions were detected predominantly in men (P = 0.036). CONCLUSION: This report is the first to determine the prevalence and MRI characteristics of calcaneal vascular remnants. Detecting and reporting this lesion on routine MRI is essential to avoid confusion with other pathologic entities.

Evaluation of the self-expanding effect of carotid stents in the early postoperative period.

PURPOSE: To evaluate the expansion effect of self-expandable stents during the first week after carotid artery stenting (CAS) procedure and to examine the variation of the effect according to the carotid plaque type. METHODS: Seventy stenotic carotid arteries of 69 patients were stented by using self-expanding Wallstents with diameters of 7 and 9 mm, after detection of stenosis and plaque type by Doppler ultrasonography. Post-stent aggressive ballooning was avoided and residual stenosis rates were measured with digital subtraction angiography. After the stenting procedure, the caudal, narrowest, and cranial diameters of stents were measured with ultrasonography at 30 min, first day and first week. Stent diameter increase and change according to plaque type were evaluated. Two-way repeated measure ANOVA test was used for statistical analysis. RESULTS: A significant increase was observed in the mean stent diameter in the three stent regions (caudal, narrow, and cranial) from the 30th minute to the first and seventh days (p < 0.001). The most prominent stent expansion occurred in the cranial and narrow segments within the first day. In the narrow stent region; Stent diameter increase between 30th minute-first day, 30th minute-first week, and first day-first week were all significant (p < 0.001). At 30 min, first day, and first week, no significant difference was detected between plaque type and stent expansion in caudal, narrow, and cranial regions (p = 0.286). CONCLUSION: We think that keeping the lumen patency limited to 30% residual stenosis after CAS procedure by applying minimal post-stenting balloon dilatation and leaving the remaining lumen expansion to the self-expanding feature of the Wallstent might be a sensible approach in order to avoid embolic events and excessive carotid sinus reactions (CSR).

Torcular pseudomass in newborns and its association with delivery: follow up or leave it alone?

PURPOSE: The cranial epidural space (ES) is a potential space and is not generally recognized unless there is underlying pathology. With MRI in newborns, we have frequently observed T2 hyperintense thickening of the ES posterior to the confluence of sinuses, also referred to as "torcular pseudomass" (TP). We aim to identify the frequency of TP and possible associations with delivery. METHODS: Retrospectively, brain MRIs of 194 neonates obtained within the first 2 weeks of life were evaluated. If TP was present, imaging characteristics and thickness were assessed by two observers, using fat-suppressed T2WI/FLAIR, T1WI, and SWI. Exclusion criteria were motion artifact, lack of sagittal T2WI, and lack of clinical data. Medical records were evaluated for demographic and clinical data. Follow-up exams were evaluated if available. Patients with TP and without were compared using Student t and chi-square tests. RESULTS: TP was present in 64/158 (40%). No difference was found between the groups regarding sex, gestational age, birth weight, delivery type, fetal presentation during delivery, birth difficulty, and neurological sequelae (p > 0.05). Eight patients with TP underwent follow-up imaging, and in 6/8, TP completely resolved. Two patients showed persistent TP, improving from 3.2 to 1 mm in one child and from 3.2 to 2.8 mm in the other within a week. CONCLUSION: TP frequently occurs in early newborns. TP does not appear to be associated with factors related to delivery, shows complete resolution in most cases with a follow-up, and is likely of no clinical importance.

An extrahepatic hydatid cyst with the fat-fluid level.

A hydatic cyst is a zoonosis caused by the larva of a tapeworm Echinococcus granulosus. The liver is the most commonly affected organ. Soft tissue localization has been reported in 2.3% of cases. Herein, we present a patient with a fat-containing hydatid cyst located in the left thigh. There are only a few reports in the literature on the presence of the fat-fluid level within a hydatid cyst. Previous studies have suggested that fat-containing hydatid cysts occur due to their cysto-biliary communication in the liver. In our case, we describe a fat-containing hydatid cyst in the extrahepatic location and discuss the pathophysiologic mechanism of fat inside it.

A common yet undescribed MRI finding in newborns: posterior epidural space edema of the cervical and upper thoracic spine.

PURPOSE: Posterior spinal epidural space (PSES) is a fat-containing space. We noted numerous spinal MRIs demonstrating T2-hyperintense thickening of the cervical/thoracic PSES in early newborns, resembling epidural edema. Our aim is to describe the appearance/frequency of this finding and explore any associations with delivery. METHODS: Retrospectively, 202 spinal/cranial MRIs, belonging to newborns within the first 2 weeks of life, were evaluated using sagittal fat-suppressed T2, T1-FLAIR, and STIR. Exclusion criteria were motion, incomplete spine imaging, lack of sagittal T2/STIR, and inadequate clinical data. Ninety-three patients were included in the final analysis. We reviewed all cases for T2 hyperintense thickened PSES and, if present, accompanying abnormal T1 signal. The spinal canal and PSES thickness were measured. Clinical and demographic data were collected. Follow-up exams were evaluated, if available. Cases with thickened PSES and without were compared. RESULTS: T2-hyperintense thickened PSES was present in 60/93 (64.5%). Mean PSES thickness was 2.3 mm (0.7-4.6). The mean PSES thickness/spinal canal diameter ratio was 0.2 (0.1-0.5). No cord compression was identified. One had a hyperintense T1 PSES signal, compatible with epidural hemorrhage. No difference was found between those with thickened PSES and without, regarding sex, gestational age, birth weight, birth method, difficult delivery, fetal position, or neurologic status (p>0.05). Follow-up imaging was available in 10, with complete resolution of T2 hyperintense PSES thickening. CONCLUSION: T2 hyperintense PSES thickening is common in imaged newborns and reversible at follow-up. No significant neurologic outcomes were found related to its presence; thus, follow-up does not appear necessary.

Isolated unilateral proximal focal femoral deficiency presenting in a young woman.

Proximal focal femoral deficiency (PFFD) is a rare congenital skeletal abnormality characterised by the partial absence of the proximal femoral segment with shortening of the entire lower extremity. It typically presents as a shortened thigh, which is flexed, externally rotated and abducted. Some other skeletal anomalies, especially fibular hemimelia, usually accompany the disorder. The diagnosis of PFFD is made in early childhood and based mainly on conventional radiography. However, the radiographic appearance of the disease evolves as the child grows. In addition, treatment procedures applied to the child affect the radiographic presentation of the disease in adulthood. Almost all cases of PFFD reported to date are in young children and in the current literature, there is a paucity of radiographic images of PFFD in mature skeleton. The aim of this case report is to present the radiographic appearance of PFFD in an adult patient and to increase awareness among radiologists about this disease.

Predictors of ileus following colorectal resections.

BACKGROUND: Ileus following colorectal surgery is a significant burden for healthcare and can be challenging to manage. This study aims to evaluate risk factors for postoperative ileus in patients undergoing colorectal surgery. METHODS: Patients who underwent colorectal resections for any diagnosis were identified from our institutional database between 2009 and 2014. Patient demographics, pre-operative comorbidities, and operation-related variables were compared in patients with and without ileus within 30 days after surgery. RESULTS: A total of 5369 patients were identified with a mean age of 53 years. 892 patients (16.6%) developed postoperative ileus. Males were twice as likely (p < 0.001) and patients with anastomosis were 1.4 times more likely to develop ileus compared to those without (p < 0.001). Laparoscopic surgery and younger age were associated with lower ileus risk. Patients with colorectal cancer, Crohn's disease, and ulcerative colitis diagnoses were all more likely to develop postoperative ileus compared to patients with diverticular disease. CONCLUSIONS: Evaluation of factors such as male gender, older age, anastomosis formation, diagnosis of cancer and inflammatory bowel disease, can help facilitate earlier diagnosis of postoperative ileus and may require consideration of prophylactic therapy.

Superficial venous thrombophlebitis caused by rocuronium.

Pain is one of the major disadvantages of rocuronium, which is used during induction of anesthesia. Even at subparalyzing doses, 50-100% of patients complain of intense pain. Sudden flexion and withdrawal movement in the wrist or arm have been reported following rocuronium use in many papers. No information about risk factors leading to this withdrawal movement or pain on injection is available and whether this reaction leads to erythema or to venous sequelae (i.e. thrombosis and thrombophlebitis) has not been systematically investigated. However, in both of our cases, visible reactions occurred and both patients were diagnosed with venous superficial thrombophlebitis. Therefore, we believe that rocuronium-related pain may, in part, be because of direct venous injury.