Efficacy of peripheral lidocaine application (neural therapy) in the treatment of neurogenic detrusor overactivity in multiple sclerosis patients.

AIMS: Many agents and treatments are used in the treatment of neurogenic detrusor overactivity (NDO) in MS patients, but no study has been conducted on the use of peripheric lidocaine (neural therapy-NT) on MS patients. We evaluated the effects of local administration of lidocaine on NDO in Multiple Sclerosis (MS) patients. METHODS: For each patient local anesthetic lidocaine was injected at each session. Sessions were held once a week for 5 weeks. At each session, Th 10-L1, urogenital segment intradermal injections, Frankenhauser, and sacral epidural injections were given. The patients had clinical and urodynamic assessment 1 month before and 3, 9, and 12 months after NT. In addition, multiple sclerosis quality of life inventory (MSQL-54) and bladder control scale (BLCS) was performed for patients. RESULTS: Twenty-eight patients were included in the study (8 males, 20 females). The patients' average age was 31.7 ± 8.1 years. The injection therapy significantly improved volume at first involuntary bladder contraction (FCV), maximal detrusor pression during filling (P det. max.), maximal cystometric bladder capacity (MCC) after 3 months. Also, the MSQL-54 and BLCS scores were improved with treatment. However, these improvements reached a maximum 3 months after treatment, but from the 9 month a regression was seen in the parameters, and after 12 months the findings were seen to be slightly above their basal levels. CONCLUSIONS: These results suggest that NDO treatment in MS patients could be an effective treatment which is easy and has very few side effects, and is cost effective.

The Effect of Lidocaine on the Experimental Model of Streptozotocin-Induced Alzheimer's Disease.

Introduction: Alzheimer's disease (AD) is a neurodegenerative disease caused by the accumulation of amyloid plaques in the cerebral cortex and hippocampus. In this study, the effects of local anesthetic lidocaine on neurodegeneration markers and memory were investigated for the first time in streptozotocin-induced rat AD model. Methods: Streptozotocin (STZ) was administered intracerebroventricularly (ICV) into Wistar rats to develop AD model. For lidocaine group (n=14), lidocaine (5 mg/kg) was administered intraperitoneally (IP) in addition to STZ injection. Control group animals (n=9) were treated with saline for 21 days. Morris Water Maze (MWM) test was performed to evaluate memory after the injections were completed. Also, the serum levels of TAR DNA-binding protein-43 (TDP-43), amyloid precursor protein (APP), ß-secretase 1, nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), response element binding protein (CREB), c-FOS were measured using ELISA test and compared between groups. Results: Lidocaine group animals showed lower escape latency and time in quadrant scores in MWM inferring better memory performance. Furthermore, lidocaine administration caused a significant decline in TDP-43 levels. However, the expression of APP and ß-secretase were significantly higher in AD and lidocaine groups compared to control group. Moreover, lidocaine group markedly had higher serum NGF, BDNF, CREB, and c-FOS levels compared to those in the AD group. Conclusion: In addition to neuroprotective effects in STZ-induced AD model, Lidocaine also appears to improve memory. This effect might be associated with increased levels of several growth factors and associated intracellular molecules. The therapeutic role of lidocaine in the pathophysiology of AD should be studied in the future.

Multicentric osteoid osteoma with a nidus located in the epiphysis.

We present a 13-year-old girl who was referred to our clinic with a 5-month history of right leg pain relieved by salicylates. Initial CT examination demonstrated a lesion in the posterior tibial cortex in keeping with an osteoid osteoma. This was resected and the diagnosis confirmed by histology. However, her pain recurred 2 weeks after the operation and further imaging identified a further nidus in the epiphysis. We present the imaging findings in this unique case of multicentric osteoid osteoma with one nidus located in the epiphysis.

Prognostic significance of maximum standardized uptake value on 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography in bone sarcomas.

OBJECTIVES: This study aims to evaluate the prognostic significance of maximum standardized uptake value (SUVmax) on 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18FDG-PET/CT) for bone sarcoma. PATIENTS AND METHODS: We retrospectively evaluated 34 patients (24 males, 10 females; mean age 36.6±24.2 years; range, 5 to 77 years) with pathologically proven bone sarcoma who underwent 18FDG-PET/CT for initial staging between September 2013 and September 2017. SUVmax of primary lesions were measured. Cumulative survival rate was calculated to evaluate the prognostic value of 18FDG-PET/CT findings. Survival duration was defined as the elapsed duration from the date of pre-treatment 18FDG-PET/CT scanning until the date of the final examination before the date of death. RESULTS: The cut-off value for SUVmax in the definition of progression was 8. Mean SUVmax of the progressive group was statistically significantly higher than the non-progressive group. Distant metastases were present in 14 (41.1%) cases. Mortality and cumulative survival rates were 14.7% and 79.1±0.08%, respectively. CONCLUSION: Semiquantitative estimation of primary tumor metabolic activity in terms of baseline SUVmax using 18FDG-PET/CT can predict the overall survival of patients with bone sarcoma.

The Accuracy of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Evaluation of Bone Lesions of Undetermined Origin.

The aim of the current study was to determine the diagnostic accuracy of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting carcinoma of unknown primary (CUP) with bone metastases. We evaluated 87 patients who were referred to FDG-PET/CT imaging and reported to have skeletal lesions with suspicion of malignancy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The median survival rate was measured to evaluate the prognostic value of the FDG-PET/CT findings. In the search for a primary, FDG-PET/CT findings correctly diagnosed lesions as the site of the primary true positive (TP) in 64 (73%) cases, 4 (5%) findings diagnosed no site of a primary, and none were subsequently proven to be true negative (TN); 14 (16%) diagnoses were false positive (FP) and 5 (6%) diagnoses were false negative (FN). Life expectancy was between 2 months and 25 months. Whole-body FDG-PET/CT imaging may be a useful method in assessing the bone lesions with suspicion of bone metastases.

Diagnostic value of single-photon emission computed tomography combined with computed tomography in relation to MRI on osteochondral lesions of the talus.

BACKGROUND: Osteochondral lesion of the talus (OLT) involves the separation of a fragment of articular cartilage, as defined by Kappis in 1922. MRI is the current standard for noninvasive diagnosis of OLT. Single-photon emission computed tomography combined with computed tomography (SPECT/CT) provides both morphologic and functional information. The purpose of the study was to compare SPECT/CT with MRI for image interpretation and treatment decision making in talar osteochondral lesions. MATERIALS AND METHODS: A total of 21 patients (four bilateral) were evaluated with MRI and SPECT/CT. Diagnostic arthroscopy was performed to validate the indication by identifying unstable cartilage areas. Activation was assessed in nine regions of interest, as described by Elias and colleagues. SPECT/CT findings were assessed by the modified scoring system of Hart and colleagues, and MRI findings with the modified classification system of Hepple and colleagues. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for SPECT/CT and MRI. RESULTS: A total of 25 lesions were identified. Seventeen lesions were located on the medial third of the talar dome, eight on the lateral third, and seven on the central third. Four patients revealed diffuse uptake on more than one zone on SPECT/CT. SPECT/CT identified two subchondral lesions, which were not visualized on MRI. CONCLUSION: MRI is the current standard for OLT diagnosis. SPECT/CT allows a three-dimensional localization of scintigraphic osteoblastic activity in the area of interest, providing additional information about the involvement of the subchondral bone and the vitality of the osteochondral lesion and the location of multiple lesions. We recommend the use of SPECT/CT and MRI together for comprehensive diagnostic assessment of OLT.

Retrospective Clinical and Radiological Outcomes after Robotic Assisted Bicompartmental Knee Arthroplasty.

Purpose. Bicompartmental knee arthroplasty (BiKA) is a favorable alternative to total knee arthroplasty for degenerative disease limited to two knee compartments. Recently developed robotic-assisted systems improved the clinical efficacy of unicompartmental knee arthroplasty by providing enhanced component positioning with dynamic ligament balancing. The purpose of this study was to evaluate the short-term outcomes of patients, undergoing bicompartmental knee arthroplasty at a single institution by a single surgeon using a robotic-assisted system. It was hypothesized that robotic assisted BiKA is a prevailing choice for degenerative disease limited to two knee compartments with good functional results. Methods. A search of the institution's joint registry was conducted to identify patients that underwent robotic-assisted BiKA of the patellofemoral compartment and the medial or lateral compartment. Results. A total number of 29 patients (30 BiKA) with a mean age of 63.6 years were identified who received a patellofemoral resurfacing in combination with medial or lateral compartment resurfacing. Twenty-four out of 29 patients had good to excellent outcome. Conclusion. Robotic assisted bicompartmental arthroplasty using broad indications and only excluding patients with severe deformity and those that have less than 4 mm of joint space in the surviving compartment demonstrated 83% good to excellent results.

Arthroscopic Excision of Acetabular Osteoid Osteoma: Computer Tomography-Guided Approach.

Osteoid osteoma is a benign osteoblastic tumor that occurs in the subcortical shaft and metaphysis of the long bones of the lower extremities; however, intra-articular lesions are also possible. Intra-articular osteoid osteomas are rare, and clinical symptoms are often less specific and, thereby, may lead to misdiagnosis. The definitive treatment for osteoid osteoma is the excision of the nidus. We present the case of a 23-year-old man with a 4-year history of right anterior hip pain, subsequently diagnosed with a subarticular osteoid osteoma located in the right anterior acetabulum. Hip arthroscopic excision of the juxta-articular osteoid osteoma is presented as an effective treatment, with the advantage of less potential damage to normal bone and cartilage, as well as the additional benefits available with hip arthroscopy.

Robotic-assisted unicompartmental knee arthroplasty.

In recent years, development of computer graphics and haptic feedback technology enabled the use of virtual reality. Virtual reality provides the opportunity to combine 3D visual imagery with interactivity, visual, and tactile realism. Robotic-assisted orthopedic surgery is defined as the use of computers and robotic technology to assist the orthopedist in providing musculoskeletal care, in which machine has the capability of precision and accuracy. Robotic-assisted orthopedic surgery is used in simulating diagnosis, preoperative and intraoperative planning, and actual surgery. One of the main areas for computer-assisted surgical applications is unicompartmental or bicompartmental knee arthroplasty, in which the clinical efficacy is improved by providing enhanced component positioning with dynamic ligament balancing.

Ischiofemoral space decompression through posterolateral approach: cutting block technique.

Ischiofemoral space impingement has become an increasingly recognized extracapsular cause of atypical hip, deep gluteal, and groin pain that can be treated endoscopically. We present a minimally invasive posterolateral technique that preserves the attachment of the iliopsoas tendon and quadratus femoris insertion while decompressing the ischiofemoral space by resecting the lesser trochanter. Furthermore, we present tips to perform this technique in a manner that minimizes the potential for damage to the sciatic nerve. This technique also allows the surgeon to treat concurrent hip pathology arthroscopically.

From the pseudolipoma to lipoma: staging of the typical radiological appearances. Pictorial essay.

Lipomas are benign mesenchymal tumors, which accounts for 50% of soft tissue tumors. Although the etiopathogenesis has not yet been fully understood, it is known that lipomas developed at a rate of 1% in the related localizations after traumas. Trauma initiates inflammatory reactions in fatty tissue and these can be the trigger mechanism for the development of lipomas. In this pictorial essay the objective was to present the imaging findings associated with the process of lipomas development. "The phases of lipomas formation" was schematized based on these data.

Imaging findings after fascial injection of tetanus vaccine.

Adverse reactions to vaccines vary from mild to fatal. Local reactions are often due to hypersensitivity to the adjuvant substances in the vaccine. This case report aims at illustrating the imaging findings of a fascial injection of the tetanus vaccine. A 14 year-old boy, vaccinated 6 months previously presented with a mass lesion in the left deltoid area. Magnetic resonance imaging and ultrasonographic evaluations were performed and the findings were characteristic for fascial granuloma. The histopathologic examination confirmed the diagnosis. In our knowledge, this is the first case of granuloma post intrafascial injection of tetanus vaccine which was MRI and ultrasonographic evaluated and histopathologicly confirmed.

Medial superior cluneal nerve entrapment neuropathy in military personnel; diagnosis and etiologic factors.

BACKGROUND AND OBJECTIVES: Pain caused by medial superior cluneal nerve entrapment (MSCNE) is an infrequent cause of unilateral low back pain. There is limited information about this neuropathy in the literature. In this study, the etiologic factors leading to this clinical entity were evaluated and also the clinical and imaging findings were examined. MATERIAL AND METHOD: The study was conducted in 3 groups. The study group included 25 patients with MSCNE, the hernia group included 25 patients with herniated nucleosus pulposus and the control group included 25 healthy subjects. The initial evaluation included lumbar computerized tomography (CT) and magnetic resonance imaging (MRI) in the study and the hernia groups. The comparisons between these two groups were made by using clinical assessment questionnaires (SF-36 mental and physical health scores and Oswestry scale). Additionally, all three groups were compared by lumbosacral radiographies and low back superficial ultrasonographies. As treatment, 1 ml of prilocaine combined with 1 ml of steroid injection was used in the study group. RESULTS: In the study group, there was no disc herniation, facet joint problems, spinal stenosis or spondylolisthesis detected by CT or MRI. The SF-36 mental health score before treatment was lower in the study group than in the hernia group. The ultrasonographic examination detected a paravertebral hypoechogenic globular-shaped muscle disorganization associated with lipomatous degeneration exclusively localized to the trigger point in the study group. Both the mean soft tissue and the periiliac band thickness were significantly higher in the study group than in the other two groups. The lumbosacral radiographies did not show any significant difference in either the degree of lumbar spinal lordosis or the intercristal line levels among the three groups. CONCLUSION: This prospective study depicts the etiologic factors, ultrasonographic features and treatment protocol of MSCNE which is usually an underestimated cause of the low-back pain. LEVEL OF EVIDENCE: Diagnostic study, Level I-1 (prospective study).

Bilateral Achilles tendon ossification: diagnosis with ultrasonography and Single Photon Emission Computed Tomography/Computed Tomography. Case report.

Ossification of the Achilles tendon is a rare clinical condition characterized by the presence of one or more segments of variable sized ossified mass within the tendon. The cause of the condition is obscure. We present the case of a 41 year-old male patient with pain in the Achilles tendon due to bilateral ossification of the tendon near the calcaneus insertion. The case was evaluated by ultrasonography, single photon emission computed tomography, and transmission computed tomography. In this case, we regarded repetitive microtrauma as the cause of the ossification based on the bilateral occurrence.

Three-dimensional scanning with dual-source computed tomography in patients with acute skeletal trauma.

OBJECTIVE: The aim of this study was to compare the efficiency of multiplanar reformatted images and three-dimensional images created after multidetector computed tomography examination in detecting acute posttraumatic osseous pathology of the skeletal system. METHOD: Between October 2006 and December 2008, 105 patients with a history of acute trauma were referred to our service. Patients were evaluated with multidetector computed tomography using multiplanary reconstructed images initially (R-I), and six months after this initial evaluation, three-dimensional images were assessed of each patient (R-II). Axial images were used for guiding as a reference Data obtained was recorded and graded according to importance levels of the pathologies. RESULTS: The R-II score was higher in the non-articular and highest in periartricular fractures of the extremities, and thoracic and pelvic cage injuries. For the spinal column, while R-I data was more significant In patients referred with polytrauma, R-II data, was more statistically significant, for short processing and adaptation time to acquiring immediate critical information. For all cases it was seen that three dimensional scans were more efficient in providing the orientation, within a short time. CONCLUSION: By dual source multidedector tomography systems trauma patients may be evaluated by multiplanary and three dimensionally reconstructed images. When used correctly, three dimensional imaging is advantageous and can help determine the exact nature and extension and also importance of osseous injuries.

Fibrin sealant in the treatment of acute ruptures of the Achilles tendon: long-term results.

OBJECTIVES: This study aims to point out the long-term results of fibrin sealant in the treatment of acute ruptures of the Achilles tendon. PATIENTS AND METHODS: Between January 1998 and December 2007, 42 patients (42 males; mean age 37.8 years; range 27 to 56 years) admitted to our clinic for acute ruptures of the Achilles tendon were treated with a fibrin sealant. The average time to surgery from injury was 2.0 (range 1 to 4) days. The patients were divided into two groups; in the first 32 patients fibrin sealant was used which was heated for preparation. In the second group of 10 patients we used fibrin sealant which did not require heating for preparation. RESULTS: The mean follow-up period was 51.5 (range 24 to 92) months. The Thermann scoring system was used to evaluate the patients postoperatively in both the early and the final follow-ups. We found that the Thermann scores of some patients slightly decreased in the advanced age group when compared to younger patients long-term, but the overall result remained unchanged by time. Only one patient needed to be re-operated for a re-rupture resulting from resumption of daily work and sports activities. CONCLUSION: Treatment of acute Achilles tendon ruptures with fibrin sealant can be one of the first choices selected because of its lower complication rate and equal results when compared to other treatment options.

Tc-MDP bone scintigraphy in a case with sporodical tumoral calcinosis.

Tumoral calcinosis is an uncommon and benign condition characterized by the presence of large calcific soft tissue deposits occurring predominantly in a periarticular location. It generally occurs as a complication of renal dialysis or trauma, and is rarely seen in familial and sporadic cases. Bone scintigraphy is a sensitive method for diagnosing tumoral calcinosis. A 28-year-old female patient with a history of operation due to tumoral calcinosis located bilateral hips, referred to our department. She had a tender palpable mass in the right knee and a fistulized incisional scar overlying the bilateral hip joints. A sporadic case of tumoral calcinosis with relapses was presented.

Three-dimensional scanning with dual-source computed tomography in patients with acute skeletal trauma

OBJECTIVE: The aim of this study was to compare the efficiency of multiplanar reformatted images and threedimensional images created after multidetector computed tomography examination in detecting acute posttraumatic osseous pathology of the skeletal system. METHOD: Between October 2006 and December 2008, 105 patients with a history of acute trauma were referred to our service. Patients were evaluated with multidetector computed tomography using multiplanary reconstructed images initially (R-I), and six months after this initial evaluation, three-dimensional images were assessed of each patient (R-II). Axial images were used for guiding as a reference Data obtained was recorded and graded according to importance levels of the pathologies. RESULTS: The R-II score was higher in the non-articular and highest in periartricular fractures of the extremities, and thoracic and pelvic cage injuries. For the spinal column, while R-I data was more significant In patients referred with polytrauma, R-II data, was more statistically significant, for short processing and adaptation time to acquiring immediate critical information. For all cases it was seen that three dimensional scans were more efficient in providing the orientation, within a short time. CONCLUSION: By dual source multidedector tomography systems trauma patients may be evaluated by multiplanary and three dimensionally reconstructed images. When used correctly, three dimensional imaging is advantageous and can help determine the exact nature and extension and also importance of osseous injuries.