Radial shock-wave therapy for frozen shoulder patients with type 2 diabetes mellitus: a pilot trial comparing two different energy levels.

BACKGROUND: Extracorporeal shock-wave therapy (ESWT) is highly recommended for the management of orthopedic shoulder pathologies. Yet, the clinical relevance of the dose difference effect of radial ESWT approaches in the management of frozen shoulder patients with type 2 diabetes mellitus remains uncertain. AIM: The aim was to examine the short-term effects of medium-and high-energy levels of radial ESWT (rESWT) in the treatment of frozen shoulder patients with type 2 diabetes mellitus. DESIGN: Prospective clinical pilot study. SETTING: This study was conducted in an outpatient clinic. POPULATION: Thirty-nine patients who had frozen shoulder untreated for at least 3 months, diagnosed with type 2 diabetes mellitus for ≥3 years were included. METHODS: The patients were randomly allocated to receive either high-energy rESWT (hrESWT), or medium-energy rESWT (mrESWT) or placebo at 8 Hz twice a week for six weeks. The primary outcome measure was pain, evaluated by the Visual Analog Scale (VAS) Score. Secondary outcome measures were function evaluated by the Shoulder Pain and Disability Index (SPADI) Score, and shoulder active range of motion (AROM). The mechanical properties of the deltoid and trapezius muscles were assessed using the MyotonPRO (Myoton AS, Tallinn, Estonia). RESULTS: The mrESWT resulted in statistically significant reductions in night pain at 6 weeks (ηp2=0.27, P=0.003). Significantly improved function (SPADI scores: -35.42±21.29 vs.-29.59±22.60; ηp2=0.39, P˂0.001) was found in both hrESWT and mrESWT group by 6 weeks. Significantly higher mean shoulder AROM values were recorded for external rotation (ηp2=0.53, P<0.001), and internal rotation (ηp2=0.21, P=0.020), in the hrESWT group at the 6th week. A significantly improved resting tone (ηp2=0.58) and stiffness of deltoid muscle (ηp2=0.62) were found in the mrESWT group (P<0.001). The trapezius muscle resting tone reduced with hrESWT (ηp2=0.17, P=0.033). CONCLUSIONS: Regardless of the energy levels, rESWT appears to be an effective therapeutic intervention for frozen shoulder patients with type 2 diabetes mellitus in the short-term results. CLINICAL REHABILITATION IMPACT: Our results suggest that this rESWT can be a useful strategy for the rehabilitation of frozen shoulder patients with type 2 diabetes mellitus. This is the first study on dose difference effectiveness in terms of the clinical significance of rESWT which is key to transfer research evidence into practice.

Spontaneous Pneumothorax Recurrence and Surgery.

Spontaneous pneumothorax that occurs in patients with no underlying lung disease is termed primary spontaneous pneumothorax (PSP). Recurrence of pneumothorax is usually seen without surgical procedures at any time. The aim of this study was to determine the recurrence time and rate of PSP after the first episode. A total of 82 PSP patients who had been treated in a thoracic surgery clinic between March 2011 and August 2012 were studied retrospectively. Video-assisted thoracoscopic surgery (VATS) was performed in 14 of 82 patients because of prolonged air leakage. These patients were excluded from the study to determine the recurrence period of PSP in our cases. Simple endotracheal intubation with low-volume high-frequency ventilation and three-port VATS technique were applied. Bullae or blebs were excised using an endoscopic linear stapler. Apical pleurectomy was performed in all of the patients. There were no cases in which VATS was converted to open thoracotomy. Recurrence of PSP was seen in 18 (26.47 %) of 68 patients. We found 26.47 % recurrence at the first 7 months, of which 94.4 % occurred at the first 6 months. About 77.77 % of these recurrences occurred at 3 months after discharge from hospital. Recurrence after the first episode of PSP is a common problem within the first 6 months. The thoracic surgeon should give knowledge about it to all patients. With the greater use of VATS for thoracic pathologies, it could be performed for the first period of pneumothorax in the future.

Synchronous bilateral typical carcinoid tumors of the lung.

A 44-year-old man was admitted to our hospital with cough and sputum symptoms. After observing bilateral masses in the chest X-ray, a tomography scan of the thorax revealed bilateral tumors. Bronchoscopic biopsies were performed. The histopathological examination showed bilateral typical carcinoid tumors. A left lower lobectomy and a right upper sleeve lobectomy were carried out subsequently. No pathological lesions were observed one year after the operation.

The diameters of common carotid artery and its branches in newborns.

The common carotid artery (CCA) bifurcation is of clinical importance due to its vascular access site for intravascular intervention. Additionally, it is also one of the most common sites of atherosclerotic plaque formation. There are numerous studies on the diameters of CCA, internal carotid artery (ICA), and external carotid artery (ECA) in adults, but few studies on newborns. Cadaver and angiographic studies have shown dimensional variations in the carotid arteries within/between individuals and also between different sexes. It is well known that the initial lesions of atherosclerosis begin very early in fetal life. Therefore, it is important to know the anatomical details of the CCA and its branches. In the present study, the neck regions of 20 (11 males and 9 females) fixed newborn cadavers were dissected. The CCAs were cut below the bulb of the carotid bifurcation further; ICA and ECA were cut above the bulb of the carotid bifurcation. The internal diameters of the CCA, ICA, and ECA were measured using a light microscopy. ECA/CCA, ICA/CCA, ICA/ECA ratios, and outflow to inflow area ratio were calculated. The mean outflow to inflow area ratio was 1.14+/-0.28. Our results highly correlated with the defined optimal ratio (1.15). The ECA/CCA, ICA/CCA, and ICA/ECA ratios were 0.78+/-0.12, 0.71+/-0.13, and 0.93+/-0.16, respectively. There were no statistically significant differences between male and female and also between right and left sides. These findings are of importance in understanding the anatomy of carotid artery during newborn period.

The anatomy of the carotico-clinoid foramen and its relation with the internal carotid artery.

The carotico-clinoid foramen is the result of ossification either of the carotico-clinoid ligament or of a dural fold extending between the anterior and middle clinoid processes of the sphenoid bone. It is anatomically important due to its relations with the cavernous sinus and its content, sphenoid sinus and pituitary gland. In this study the ossification state of the carotico-clinoid ligament, the diameter of the internal carotid artery and the carotico-clinoid foramen has been studied on 50 autopsy cases. Of the 100 carotico-clinoid foramina examined, in 27 sides (15 right, 12 left) the carotico-clinoid ligament was completely ossified, in 18 sides (9 right, 9 left) the carotico-clinoid ligament was incompletely ossified and in 55 sides (26 right, 29 left) it was a ligamentous structure. The correlation of the dimensions of the carotico-clinoid foramen and the internal carotid artery showed no statistical significance, except between the carotico-clinoid foramen with a fibrous carotico-clinoid ligament and the internal carotid artery on the right side (p=0.007, r=0.51). The existence of a bony carotico-clinoid foramen may cause compression, tightening or stretching of the internal carotid artery. Further, removing the anterior clinoid process is an important step in regional surgery; the presence of a bony carotico-clinoid foramen may have high risk. Therefore, detailed knowledge of the type of ossification between the anterior and middle clinoid processes can be necessary to increase the success of regional surgery.