Dynamic Quantitative Imaging of the Masseter Muscles in Bruxism Patients with Myofascial Pain: Could It Be an Objective Biomarker?

We aimed to investigate whether the collaboration of shear wave elastosonography (SWE) and B-mode ultrasonography (US) could be offered as diagnostic tools to assess the presence, severity, and progress of bruxism, as well as a biomarker for the effectiveness of treatment in daily clinical practice. The study was designed as a quantitative evaluation of the masseter muscles (MMs) of the clinically diagnosed bruxism patients suffering from myofascial pain and MMs of the healthy individuals. Clinical examinations were made according to the diagnostic criteria for temporomandibular disorders (DC/TMD), and pain was assessed using a visual analog scale (VAS). Painful MMs with VAS scores ≥ 4 were assigned to Group A, and healthy MMs were assigned to Group B. Also, the MMs of the painful bruxers were analyzed based on wearing occlusal splints. Group A was divided into two subgroups as splint users (Group AI) and non-users (Group AII). All the participants were scanned with dynamic US and SWE to quantify the size and stiffness of the MMs. Measurements of each muscle pair while the jaw is in a resting position (relaxation) and clenching position (contraction) were recorded. The significant differences in stiffness and thickness became visible in the relaxation state. Bruxism patients with myofascial pain had significantly harder and thinner MMs than healthy individuals. During the relaxation, the mean thickness and elasticity values were 9.17 ± 0.40 mm and 39.13 ± 4.52 kPa for Group A and 10.38 ± 0.27 and 27.73 ± 1.92 for Group B, respectively. Also, stiffer MMs were measured in Group AII (38.16 ± 3.61 kPa) than in Group AI (26.91 ± 2.13 kPa). In conclusion, the combination of SWE and US using a dynamic examination technique has the potential to be a valuable tool for the management of bruxism patients suffering from myofascial pain.

Can treatment with teicoplanin improve the prognosis of COVID-19 patients?

AIM: In patients with COVID-19, no validated efficient treatment has been reported. Herein, we examine the effect of treatment with teicoplanin in hospitalised patients with COVID-19. METHODS: This retrospective study included 115 hospitalised patients in one medical centre. Fifty-four patients with laboratory-confirmed COVID-19 who received teicoplanin plus standard care were included in the Teicoplanin arm of this study, whereas 61 patients who were treated with standard care (SC) according to the Turkish Health Organization guidelines were included in the control arm. Patients' baseline characteristics, clinical presentation, treatment and outcomes were compared between the two groups. RESULTS: In this non-randomised control study, all baseline characteristics were comparable between the two arms and there were no significant differences in the presenting symptoms, comorbidities and clinical outcomes between the two groups. However, the mortality rate was significantly lower in the teicoplanin group than in the control group (1.9% vs 14.8%; P < .05). In addition, no adverse reactions were found in the teicoplanin arm. CONCLUSIONS: Teicoplanin administration is associated significantly with lower mortality in hospitalised patients with COVID-19 in our study. Further clinical investigations is required to verify the role of teicoplanin in COVID-19 patients.

Symptomatic Bilateral Xanthogranuloma of the Choroid Plexus.

Xanthogranulomas (XGRs) of the choroid plexus are rare, asymptomatic, and benign lesions usually found incidentally. Here, we present a case of a 47-year-old male with bilateral XGR of the choroid plexus with periventricular edema and discuss our case in relation to a review of existing literature pertaining to the radiology of XGRs. To the best of our knowledge, this is the first reported case of bilateral trigonal XGR causing brain edema without ventricular dilatation. Despite the fact that they can cause hydrocephalus, XGRs are silent and benign lesions. Although the etiopathology of XGRs remains poorly understood, enhanced imaging analyses may provide additional information regarding edema and focal white matter signal changes.

Limbic Encephalitis Associated with Sjögren's Syndrome: Report of Three Cases.

Sjögren's syndrome (SS) may be complicated by neurological manifestations. We herein report three women (age range 26-60 years old) who all presented with limbic encephalitis (LE) as the predominant clinical feature 3 months to 15 years after the diagnosis of SS. The 26-year-old patient also developed acute motor axonal neuropathy one week after autoimmune encephalitis. All three patients showed contrast-enhanced MRI lesions and inflammatory cerebrospinal fluid findings, while not displaying any anti-neuronal antibodies and showing a remarkable response to immunotherapy. SS is often overlooked when the symptoms are mild. Therefore, in LE cases with no identifiable cause, serological screening for rheumatologic disorders is recommended.

Cranial imaging findings in neurobrucellosis: results of Istanbul-3 study.

OBJECTIVE: Neuroimaging abnormalities in central nervous system (CNS) brucellosis are not well documented. The purpose of this study was to evaluate the prevalence of imaging abnormalities in neurobrucellosis and to identify factors associated with leptomeningeal and basal enhancement, which frequently results in unfavorable outcomes. METHODS: Istanbul-3 study evaluated 263 adult patients with CNS brucellosis from 26 referral centers and reviewed their 242 magnetic resonance imaging (MRI) and 226 computerized tomography (CT) scans of the brain. RESULTS: A normal CT or MRI scan was seen in 143 of 263 patients (54.3 %). Abnormal imaging findings were grouped into the following four categories: (a) inflammatory findings: leptomeningeal involvements (44), basal meningeal enhancements (30), cranial nerve involvements (14), spinal nerve roots enhancement (8), brain abscesses (7), granulomas (6), and arachnoiditis (4). (b) White-matter involvement: white-matter involvement (32) with or without demyelinating lesions (7). (c) Vascular involvement: vascular involvement (42) mostly with chronic cerebral ischemic changes (37). (d) Hydrocephalus/cerebral edema: hydrocephalus (20) and brain edema (40). On multivariate logistic regression analysis duration of symptoms since the onset (OR 1.007; 95 % CI 1-28, p = 0.01), polyneuropathy and radiculopathy (OR 5.4; 95 % CI 1.002-1.013, p = 0.044), cerebrospinal fluid (CSF)/serum glucose rate (OR 0.001; 95 % CI 000-0.067, p = 0.001), and CSF protein (OR 2.5; 95 % CI 2.3-2.7, p = 0.0001) were associated with diffuse inflammation. CONCLUSIONS: In this study, 45 % of neurobrucellosis patients had abnormal neuroimaging findings. The duration of symptoms, polyneuropathy and radiculopathy, high CSF protein level, and low CSF/serum glucose rate were associated with inflammatory findings on imaging analyses.

Differentiation of benign from malignant cervical lymph nodes in patients with head and neck cancer using PET/CT imaging.

PURPOSE: To differentiate malignant from benign cervical lymph nodes in patients with head/neck cancer. METHODS: In this retrospective study, 39 patients with primary head/neck cancer who underwent Positron Emission Tomography (PET)/Computerized Tomography (CT) and image-guided lymph node biopsy were included. RESULTS: Overall, 23 (59%) patients had biopsy-proven malignant cervical lymphadenopathy. Malignant lymph nodes had higher maximum standardized uptake (SUV-max) value (P<.001) and short-axis diameter (P=.015) compared to benign nodes. An SUV-max of ≥2.5 was 100% sensitive, and an SUV-max ≥5.5 was 100% specific for malignant lymphadenopathy. CONCLUSION: The PET/CT SUV-max value can help with differentiation of malignant cervical lymph nodes in patients with head/neck cancer.

The use of 18F-FDG PET ratios in the differential diagnosis of common malignant brain tumors.

OBJECTIVE: This study examined the use of positron emission tomography (PET) ratios to improve the diagnostic ability of 18F-FDG PET/computed tomography (CT) in the differentiation of enhancing brain metastases, central nervous system lymphomas, and gliomas. MATERIALS AND METHODS: Seventy-six patients with malignant brain tumors and available magnetic resonance imaging and PET/CT examinations were included. RESULTS: Among standardized uptake value (SUV)-related parameters tested, tumor maximum SUV to ipsilateral cortex maximum SUV ratio (Tmax:WMimax) and maximum SUV (SUVmax) proved to be the two most valuable parameters for differential diagnosis. CONCLUSION: In addition to SUVmax, Tmax:WMimax also seems to provide helpful information for the differential diagnosis of lymphomas from other malignant brain tumors.

Fecal tag CT colonography with a limited 2-day bowel preparation following incomplete colonoscopy.

PURPOSE: This study aimed to assess the feasibility and patient tolerance of a 2-day limited fecal tag bowel preparation in computed tomographic colonography (CTC) performed for incomplete conventional colonoscopy (CC) patients. MATERIALS AND METHODS: Seventy-five patients who underwent a CTC examination fbecause of incomplete CC were included. A low-residue diet was given for 2 days before CTC. Fecal tagging (FT) was done using a barium sulfate suspension. The quality of the preparation, success of tagging and patient experience with the bowel preparation were investigated. RESULTS: Four hundred fifty bowel segments were evaluated. The number of solid stool balls of 6-9 mm size was 284; the corresponding figure was 93 for solid stool balls ≥ 10 mm. Residual fluid was present in about one-third of the segments. The fecal tagging efficacy for ≥ 6 mm residual stool balls was 92 %. Overall, 16 (21.3 %) patients presented with colonic lesions at CTC. Three out of four colonic mass lesions had not been diagnosed with CC. Most patients reported mild discomfort. CONCLUSION: FT-CTC performed after a limited 2-day bowel preparation seems to be a technically feasible, safe and acceptable procedure that allows a complete a colonic study in incomplete CC patients.

Comparison of a 4-Day versus 2-Day Low Fiber Diet Regimen in Barium Tagging CT Colonography in Incomplete Colonoscopy Patients.

Our aim was to compare the amount of residual feces, residual fluid, the tagging quality, and patient compliance using 4-day versus 2-day low fiber diet regimen in barium tagging CT colonography in incomplete colonoscopy patients. Methods. A total of 101 patients who underwent CT colonography were assigned to 2-day diet group (n = 56) and 4-day diet group (n = 45). Fecal tagging was achieved with barium sulphate while bisacodyl and sennoside B were used for bowel preparation. Residual solid stool was divided into two groups measuring <6 mm and ≥6 mm. We graded the residual fluid, tagging quality for solid stool, and fluid per bowel segment. We performed a questionnaire to assess patient compliance. Results. 604 bowel segments were evaluated. There was no significant difference between 2-day and 4-day diet groups with respect to residual solid stool, residual fluid, tagging quality for stool, and fluid observed in fecal tag CT colonography (P > 0.05). The prevalence of moderate discomfort was significantly higher in 4-day group (P < 0.001). Conclusion. Our study shows that 2-day limited bowel preparation regimen for fecal tag CT colonography is a safe and reasonable technique to evaluate the entire colon, particularly in incomplete conventional colonoscopy patients.

The efficacy of diffusion weighted imaging for detection of acute pancreatitis and comparison of subgroups according to Balthazar classification.

BACKGROUND/AIMS: The aim of this study was to measure the apparent diffusion coefficient (ADC) values detected by diffusion-weighted imaging (DWI) in acute pancreatitis and compare them with computerized tomography (CT) findings in acute pancreatitis subgrouped by the Balthazar classification. MATERIALS AND METHODS: The study population included 50 patients diagnosed with clinical pancreatitis who were evaluated with both multidetector CT and magnetic resonance imaging (MRI) within 24 h of clinical presentation. We calculated pancreatic ADC values obtained from DWI (b=0 and b=1000 mm2/sn). These values were compared with their normal counterparts (n=24). The patients with acute pancreatitis were subgrouped according to the Balthazar classification. The mean ADC values were calculated in each subgroup, and they were compared with control ADC values. RESULTS: The mean pancreatic ADC values in acute pancreatitis (1.19×10(-3) mm2/sn ±0.32) was significantly lower than in the normal group (1.78×10(-3) mm2/sn ±0.29) (p<0.001). In the subgroup analysis, ADC values in each group were significantly lower than in the control group (p<0.001). In addition, as severity of pancreatitis increased according to the Balthazar classification, lower ADC values were noted. CONCLUSION: DWI with MRI and ADC values are helpful in the diagnosis of all subgroups of acute pancreatitis. Due to the lack of CT findings in grade A patients, DWI may be helpful in the diagnosis in this group as well.

[Isolated hyoid bone fracture due to blunt trauma: case report]. / Künt travma sonucu gelisen izole hiyoid kirigi: Olgu sunumu.

Fractures of the hyoid bone are very rare. Diagnosis of hyoid fracture is difficult and can be made only with a strong degree of suspicion. We report a case of isolated hyoid bone fracture due to blunt trauma to the neck. A 26-year-old woman was admitted to emergency department for motor vehicle accident. She complained of dysphagia and anterior neck discomfort. Physical examination showed hyperemia and tenderness of neck. A tomographic scan of neck was performed. The findings demonstrated hyoid fracture. Patient was observed with medical therapy for 24 hours and discharged with recommendation of outpatient control.Emergency physician has to be aware of the possibility of hyoid fractures in blunt traumas. Patients with hyoid fracture should be observed for 24 hours. Generally, medical treatment is satisfactory in isolated hyoid fractures.

Topographic evaluation of the medial canthus-alar groove line in terms of determining the boundaries of lateral osteotomies.

UNLABELLED: Nasolacrimal duct injury is a rare complication of rhinoplasty. Detailed regional anatomy knowledge is mandatory to avoid this complication. To display a reference line to protect the nasolacrimal duct from injury during lateral osteotomy, dacryocystography images of 10 patients who underwent rhinoplasty surgery at the authors' clinic were obtained. Lateral osteotomy lines and a line from the medial canthus to the alar groove were marked with radio-opaque wires before procedures. Horizontal and sagittal distances from these lines to the nasolacrimal duct were measured at the beginning, midpoint, and end of the nasolacrimal duct. No sign of nasolacrimal duct injury was observed postoperatively. The mean horizontal distances from the osteotomy lines to the nasolacrimal duct entrance, midpoint, and exit were respectively 0.23 ± 0.12 cm, 0.25 ± 0.11 cm, and 0.24 ± 0.11 cm, and the mean sagittal distances were respectively 0.61 ± 0.21 cm, 1.96 ± 0.28 cm, and 2.38 ± 0.32 cm. The mean horizontal distances from the medial canthus-alar groove line to the nasolacrimal duct entrance, midpoint, and exit were respectively 0.57 ± 0.1 cm, 0.51 ± 0.1 cm, and 0.46 ± 0.13 cm, and the mean sagittal distances were 0.91 ± 0.27 cm, 1.34 ± 0.27 cm, and 1.79 ± 0.3 cm. The osteotomy lines and the nasolacrimal duct were closest in the medial canthal region. The imaginary line from the medial canthus to the junction of the alar wings and cheek was always lateral and anterior to the nasolacrimal duct. Considering the three-dimensional shape of the nose, especially its projection, placement of lateral osteotomies medial to the medial canthus-alar groove line would decrease the risk of nasolacrimal duct injury. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Does smoking affect thyroid gland enlargement and nodule formation in iodine-sufficient regions?

OBJECTIVES: The present study aimed to investigate the effect of smoking on thyroid nodule formation and goiter development in healthy subjects living in Istanbul, an iodine-sufficient region. This study was designed as a prospective, randomized, and observational study. METHODS: Included in the study were voluntary hospital staff and relatives of patients between the ages of 28 and 71 who had no known disease or drug use, who have been living in Istanbul and had been smoking more than 10 cigarettes per day for at least 10years. Nonsmoker volunteers (45) shared similar demographic characteristics and were matched for age to the (46) smokers. By means of thyroid ultrasounds performed in all participants, volumes of the right and left lobes of the thyroid gland, and number, diameter and characteristics of nodules were evaluated. RESULTS: Comparing the smokers and nonsmokers, no statistically significant difference was determined in terms of presence of nodules and volumes of the left and right thyroid lobes (P=0.68, P=0.09, and P=0.63, respectively). Making enhanced diffuse enlargement of the thyroid gland, but not to a statistically significant degree. Smoking was observed to have no effect on non-toxic nodules, or the levels of thyroid-stimulating hormone, free thyroxin, free triiodothyronine, anti-thyroid peroxidase, or anti-thyroglobulin antibodies. CONCLUSIONS: Smoking does not effect, to a statistically significant degree goiter development thyroid nodule formation in iodine-sufficient regions like Istanbul.

Plexiform schwannoma of the duodenum accompanying pyloric stenosis: report of a case.

Plexiform schwannoma is a benign peripheral nerve sheath tumor and is composed of Schwann cells arranged in a plexiform pattern. Most plexiform schwannomas are skin tumors, and there has been no case report of this tumor originating in the duodenum. We describe the first known case of plexiform schwannoma of the duodenum. A 60-year-old man presented with a short history of food intolerance, epigastric discomfort, fullness and bloatedness, sometimes vomiting, and weight loss, without any clinical picture of neurofibromatosis. Upper gastrointestinal endoscopy revealed pyloric stenosis with normal mucosal lining. The computed tomography demonstrated circumferentially and concentrically thickened pylorus up to 18 mm with narrowed lumen and limited contrast passage. Antrectomy and gastrojejunostomy were performed due to unknown etiology of the obstruction. The cut surface of the lesion revealed thickened pylorus up to 15 mm in a circumferential manner. It contained a 5 mm tumor consisted of multiple white nodules in the submucosal and subserosal layers with overlying duodenal mucosa. Microscopic examination revealed nodular structures composed of spindle cells within fascicular pattern without any atypia or mitosis. Immunohistochemical examination revealed that the cells diffusely and strongly expressed S100 proteins in a nuclear and cytoplasmic pattern, but not CD117, smooth muscle actin, desmin, or CD34, confirming plexiform schwannoma.

Adenotonsillar hypertrophy: correlation between obstruction types and cardiopulmonary complications.

OBJECTIVES/HYPOTHESIS: To evaluate the association of upper airway obstruction (UAO) type and cardiopulmonary complications in children. The effect of obstruction type on quality of life and severity of obstructive symptoms were also investigated. STUDY DESIGN: Cross-sectional study. METHODS: A Brodsky scale and adenoid-nasopharynx ratio (ANR) were used to categorize tonsil and adenoid size, respectively. The patients were divided into four groups according to obstruction type: adenoid hypertrophy only (ANR ≥ 0.63, tonsil grade 1 or 2), adenoid and tonsil hypertrophy (ANR ≥ 0.63, tonsil grade 3 or 4), tonsillar hypertrophy only (ANR < 0.63, tonsil grade 3 or 4), and normal (ANR < 0.63, tonsil grade 1 or 2). Mean pulmonary artery pressure (MPAP), tricuspid annular plane systolic excursion (TAPSE), and right ventricle myocardial performance index (RVMPI) were evaluated for each patient. The obstructive sleep apnea questionnaire (OSA-18) and Brouilette symptom score questionnaire were completed by each child's parents. RESULTS: MPAP was higher in patients with adenoid hypertrophy and adenoid and tonsil hypertrophy in comparison with the normal group. The P values were .079 and .055, respectively, when comparing TAPSE and RVMPI measurents in adenoid and tonsil hypertrophy and normal patients. A significant correlation was found between ANR and MPAP, RVMP, and TAPSE. The patients in the adenoid and tonsil hypertrophy group had the highest Brouilette symptom and OSA-18 scores. CONCLUSIONS: Patients with adenoid and tonsil hypertrophy are at a higher risk for cardiopulmonary complications, poorer quality of life, and more severe UAO symptoms and should have priority for surgical treatment to prevent cardiopulmonary complications.

Deep neck space infections: a retrospective review of 173 cases.

PURPOSE: The purpose of this study is to review our recent experience with deep neck infections and emphasize the importance of radiologic evaluation and appropriate treatment selection in those patients. MATERIALS AND METHODS: The records of 173 patients treated for deep neck infection at the Department of Otolaryngology and Head and Neck Surgery of Dicle University Hospital during the period from 2003 to 2010 were retrospectively reviewed. Their demography, symptoms, etiology, seasonal distribution, bacteriology, radiology, site of deep neck infection, durations of the hospital admission and hospital stay, treatment, complications, and outcomes were evaluated. The findings were compared to those in the available literature. RESULTS: Dental infection was the most common cause of deep neck infection (48.6%). Peritonsillar infections (19.7%) and tuberculosis (6.9%) were the other most common cause. Pain, odynophagia, dysphagia, and fever were the most common presenting symptoms. Radiologic evaluation was performed on almost all of the patients (98.3%) to identify the location, extent, and character (cellulitis or abscesses) of the infections. Computed tomography was performed in 85.3% of patients. The most common involved site was the submandibular space (26.1%). In 29.5% of cases, the infection involved more than one space. All the patients were taken to intravenous antibiotic therapy. Surgical intervention was required in 95 patients (59.5%), whereas 78 patients (40.5%) were treated with intravenous antibiotic therapy alone. Life-threatening complications were developed in 13.8% of cases; 170 patients (98.3%) were discharged in stable condition. CONCLUSION: Despite the wide use of antibiotics, deep neck space infections are commonly seen. Today, complications of deep neck infections are often life threatening. Although surgical drainage remains the main method of treating deep neck abscesses, conservative medical treatment are effective in selective cases.

Effects of paramagnetic contrast agents on the gallbladder volume.

PURPOSE: Iodinated contrast agents lead to contraction of the gallbladder. The purpose of this prospective study was to investigate whether the paramagnetic contrast agents used for magnetic resonance imaging (MRI) cause volume changes in gallbladder or not. MATERIALS AND METHODS: The gallbladder volume changes were evaluated by ultrasound just before and 15 minutes after the imaging procedure in 10 patients without any paramagnetic contrast agent administration and 36 patients in whom paramagnetic contrast agents were administered during MRI. Gallbladder volume measurements before and 15 minutes after MRI were compared with each other. RESULTS: The mean pre- and post-procedural gallbladder volumes in patients on paramagnetic contrast agents were 30.2 +/- 19.3 cm(3) and 27.8 +/- 13.5 cm(3), respectively. They were 31.8 +/- 15.0 cm(3) and 29.5 +/- 9.3 cm(3), respectively, in patients who were not administered any paramagnetic contrast agent. There were no statistically significant difference between groups, regarding pre- and post-MRI gallbladder volumes. CONCLUSION: MRI, with or without paramagnetic contrast agents, does not lead to gallbladder volume contraction. In that regard, there appears to be no need to avoid ultrasound aimed to evaluate the gallbladder after MRI examinations.