Nurdan Cay

Increased level of red blood cell distribution width is associated with deep venous thrombosis.

Previous studies have demonstrated a significant association between red blood cell distribution width (RDW) and acute pulmonary embolism. To the authors’ knowledge no study has been reported in patients with deep venous thrombosis (DVT). A total of 431 lower extremity venous duplex examinations were included in the study. Of these, 216 examinations with the diagnosis of DVT were compared to 215 examinations with normal duplex findings with respect to RDW. The two groups were well matched. DVT group had a higher median value and the interquartile range (25th and 75th) of RDW (%) level [14.9 (14.2–16.7)] compared to control group [14.4 (13.6–15.2); P <0.001], respectively. Patients were divided into tertiles based on RDW. DVT was detected in 42 patients (31.6%) in the lowest tertile, in 81 (53.3%) in the middle tertile, and in 93 (63.7%) in the highest tertile (P <0.001). In multivariate analysis after adjustment for confounding variables, RDW was the only parameter to predict the presence of DVT [odds ratio (OR) 1.37; 95% confidence interval (CI) 1.21–1.55; P <0.001]. After removing patients with chronic DVT, the interquartile range (25th and 75th) of the RDW (%) level was also higher in the DVT group [15.0 (14.2–16.7)] compared with the control group [14.4 (13.6–15.2); P < 0.001], respectively. In addition, in proximal DVT, the significant difference continued to be present, although this significance was lost in distal DVT [14.4% (13.6–15.2) vs. 16.1% (15.1–17.4), P <0.001 and 14.4% (13.6–15.2) vs. 14.3% (14.2–14.7), P = 0.959]. In multivariate analysis, RDW was an independent predictor of risk of proximal DVT (OR 1.60; 95% CI 1.39–1.84; P <0.001). RDW (%) level was significantly higher in patients with bilateral DVT than in patients with unilateral DVT [16.0 (14.8–17.1) vs. 14.4 (14.2–14.8), P <0.001, respectively]. In receiver operating characteristics curve analysis, RDW more than 14.9% had 85% sensitivity and 73% specificity in predicting proximal DVT. RDW, an inexpensive and easily measurable laboratory variable, was independently and significantly associated with the presence and severity of DVT, especially nonchronic proximal DVT. The mechanism of association requires, however, further study.

Ischiofemoral impingement in an 11-year-old girl.

Ischiofemoral impingement (IFI) is the entrapment of the quadratus femoris muscle (QFM) between the trochanter minor of the femur and the ischium-hamstring tendon. Patients with IFI generally present with hip pain, which may radiate toward the knee. Although there is no specific diagnostic clinical test for this disorder, the presence of QFM edema/fatty replacement and narrowing of the ischiofemoral space and the quadratus femoris space on magnetic resonance imaging (MRI) are suggestive of IFI. The optimal treatment strategy of this syndrome remains obscure. Patients may benefit from a conservative treatment regimen that includes rest, activity restriction, nonsteroidal anti-inflammatory drugs, and rehabilitation procedures, just as with other impingement syndromes. Herein we report an 11-year-old girl with IFI who was successfully treated conservatively. To our knowledge, our case is the youngest patient reported in the English literature. MRI remains an important tool in the diagnosis of IFI, and radiologists should be aware of the specific features of this entity.

Platelet activity indices in patients with deep vein thrombosis.

Background: Extensive research has been performed regarding the association between platelet activity indices and various cardiovascular disorders. Less clear data, however, are present between these indices and deep vein thrombosis (DVT). Aim: The aim of this study was to investigate the association between platelet activity indices and DVT in a relatively large population. Methods: Mean platelet volume (MPV), mean platelet mass (MPM), and mean platelet component (MPC) were measured by an autoanalyzer in a total of 203 patients with DVT and the results were compared with 210 age- and sex-matched controls without DVT. Results: There were significant differences between the study and control groups in MPV (8.6 ± 1.3 fL vs 7.9 ± 0.5 fL [95% CI −0.82 to −0.44], P < .001, respectively), MPM (2.2 ± 0.3 pg vs 2.0 ± 0.1 pg [95% CI −0.20 to −0.11], P < .001, respectively), and MPC (24.9 ± 3.2 g/dL vs 26.3 ± 1.6 g/dL [95% CI 0.91 to 1.89], P < .001, respectively). These 3 platelet activity indices were also found to be significant predictors of the presence of DVT (all Ps < .001). Conclusion: In patients with DVT, the presence of DVT was closely associated with increased platelet activation. The MPV, MPM, and MPC may identify patients requiring aggressive antiplatelet treatment.

Comparison of 21 and 27 gauge needles for determining sample adequacy in the aspiration biopsy of thyroid nodules.

PURPOSE To compare 21 and 27 gauge (G) needles used for fine-needle aspiration (FNA) of thyroid nodules to obtain better specimens for adequacy and cytological diagnosis. MATERIALS AND METHODS One hundred patients with thyroid nodules (100 nodules) were included in this study. Each nodule was aspirated with both 27 G and 21 G needles. The obtained aspirates were classified as adequate and inadequate by two separate cytopathologists. The results were analyzed by appropriate statistical methods. RESULTS There was no statistically significant difference between 21 G and 27 G needles in terms of adequacy, according to each pathologist (P > 0.05). After pathological evaluation with consensus, the adequacy prevalence was the same (84%) for both needle types in all study populations (P > 0.05). According to the ultrasound characteristics of nodules, the prevalence of inadequate samples in patients with hypoechoic or heterogeneous nodules was significantly higher compared with the prevalence of inadequate samples in patients with isoechoic or hyperechoic nodules for both types of needles (P < 0.05). However, according to the size of the needles, there was no significant difference between hypoechoic and heterogeneous nodules or between isoechoic and hyperechoic nodules with regard to the ability to yield adequate samples (P > 0.05). CONCLUSION The results of our study showed that FNA with 27 G needles can aspirate adequate material for cytopathological diagnosis. The probability of inadequate sample aspiration of hypoechoic and heterogeneous nodules is higher than that for other nodule types.

Glenoid axis is not related with rotator cuff tears—a magnetic resonance imaging comparative study

PurposeThe relationship between glenoid version angle and rotator cuff pathology has been described. However, the effect of glenoid version angle on rotator cuff pathology is still unknown. The aim of this study was to investigate whether there is an impact of glenoid version angle on rotator cuff pathology.MethodsAll shoulder MRI examinations performed in the study centres between August 2008 and August 2009 were evaluated retrospectively. Shoulder MRI examinations having rotator cuff pathology such as trauma, degeneration, and acromion type 2-3-4 reported in previous studies were excluded from the study. Sixty-two shoulder MRIs with rotator cuff pathology having type 1 acromion morphology and 60 shoulder exams without rotator cuff pathology were included in the study. Glenoid version angle was calculated in axial images. Rotator cuff was evaluated in fat-suppressed T2-weighted and proton density-weighted images.ResultThe mean values for glenoid version angle were 2.41° and 0.61° in the control and the study groups, respectively. No statistically significant difference was found between the two groups (p > 0.05). In addition, 26.6% and 33.8% of the glenoids were retroverted and 73.4% and 66.2% were anteverted in the control and the study groups, respectively (all p > 0.05).ConclusionThis study demonstrated no significant relationship between glenoid version angle and rotator cuff pathology. Therefore, the pathologies that can be related to the cuff itself should be investigated if the pathology cannot be explained by an extrinsic cause in subjects with rotator cuff pathology.

The effect of morphometric relationship between the glenoid fossa and the humeral head on rotator cuff pathology

OBJECTIVE The aim of this study was to investigate the impact of the morphometric association between the glenoid fossa and the humeral head on rotator cuff pathology. METHODS Shoulder MRI examinations performed for any cause in study centers between August 2008 and August 2009 were retrospectively evaluated. Shoulder MRI exams having rotator cuff pathology, such as trauma, degeneration, and acromion Type 2, 3 and 4 were excluded. The study included 62 shoulder exams with rotator cuff pathology having Type 1 acromion morphology and 60 shoulder exams without rotator cuff pathology (control group). Glenoid anteroposterior distance and the humeral head diameter in axial images, humeral head diameter and glenoid articular surface diameter in coronal images and their ratios were measured in both groups. Subacromial distance was measured using sagittal images. The rotator cuff was evaluated in fat-suppressed T2-weighted and proton density-weighted images. RESULTS The difference between subacromial distances in the rotator cuff pathology group (8.94 ± 1.43 mm) and control group (10.96 ± 1.62 mm) was statistically significant (p<0.001). There was no statistical significance between the two groups in humeral head diameter, glenoid articular surface diameter, glenoid anteroposterior distance and their ratios (p>0.05). CONCLUSION There is no association between the humeral head and the glenoid articular surface which can result in rotator cuff pathology. The glenohumeral joint was determined as a compatible joint morphometrically. Therefore, if they cannot be explained by an extrinsic cause, pathologies related to the rotator cuff itself should be investigated in subjects with rotator cuff pathology.

Impact of fibular torsion and rotation on chronic ankle instability

BACKGROUND The fibula is known not to involve in transmission of weight but known simply as an ankle stabilizer. However, its main function in stabilizing the ankle remains obscure. Since the fibula has an impact on torsion and rotation of the ankle, its effect on lateral ankle instability should be investigated. MATERIALS AND METHODS Twenty patients with lateral ankle instability (Group 1) and 19 healthy volunteers (Group 2) were included in the study. The tibiofibular and talofibular relationships were evaluated using MRI images. Fibular torsion and rotation angles were calculated using a new method. Range of motion of the ankle joint was investigated while the knee was at flexion (90°) and extension (0°). The comparisons performed between the 2 groups and independent from the groups were statistically evaluated and, the p value of <0.05 was considered as statistically significant. RESULTS A significant difference was found between the two groups for age (p<0.05). There were no statistically significant differences between the right and left sides for all measurements in the group 1 and 2 (p>0.05). There was a statistically significant difference between the two groups in dorsal flexion when the knee is at flexion (90°) and extension (0°) position. There was also a statistically significant difference between the two groups in plantar flexion which was measured while the knee was at extension (0°) position. No statistically significant difference was found between both groups in terms of fibular torsion and rotation. However, independent from the groups when the patients were divided into 2 groups according to whether the fibula localized posteriorly or not, in patients with posteriorly localized fibula it was demonstrated that the fibular torsion and rotation was increased significantly. CONCLUSION We did not detect any relationship between fibular torsion and rotation and ankle instability. However, independent from the groups when the patients were divided into 2 groups according to whether the fibula localized posteriorly or not, we realized that in patients with posteriorly localized fibula, fibular torsion and rotation significantly increased. This finding did not explain the cause of instability. However, it may gain significance with new further studies regarding ankle instability.

Use of contact pressure-sensitive surfaces as an indicator of graft tension in medial patellofemoral ligament reconstruction

BackgroundNo previous description has been made about an objective method to test the graft resistance in MPFL reconstruction intraoperatively. In our study, we aimed to obtain intraoperative objective data about the graft resistance using contact pressure-sensitive surfaces and measuring pressure formed under the graft.Materials and methodsIn 2012, double-layered contact pressure-sensitive Fuji Prescale Film bands were placed under MPFL in 15 fresh-frozen high above-knee amputates (Group 1) and under graft in 10 patients who underwent MPFL reconstruction (Group 2). Measured values at different flexion angles were compared between and in groups.ResultsStatistical analysis was performed by Student’s t test. It has been found that the pressure under the graft was higher in patients having reconstruction as compared to the pressure under natural MPFL. Decreasing pressure values were observed with increasing flexion angles in both groups.ConclusionContact pressure-sensitive surfaces provided objective data when placed under the graft in natural MPFL and during surgery. Therefore, they may be used as an objective marker providing information about graft resistance.

Strain ratio measurement of femoral cartilage by real-time elastosonography: preliminary results

ObjectiveThe purpose of this study was to evaluate strain ratio measurement of femoral cartilage using real-time elastosonography.MethodsTwenty-five patients with femoral cartilage pathology on MRI (study group) were prospectively compared with 25 subjects with normal findings on MRI (control group) using real-time elastosonography. Strain ratio measurements of pathologic and normal cartilage were performed and compared, both within the study group and between the two groups.ResultsElastosonography colour-scale coding showed a colour change from blue to red in pathologic cartilage and only blue colour-coding in normal cartilage. In the study group, the median strain ratio was higher in pathologic cartilage areas compared to normal areas (median, 1.49 [interquartile range, 0.80–2.53] vs. median, 0.01 [interquartile range, 0.01–0.01], p < 0.001, respectively). The median strain ratio of the control group was 0.01 (interquartile range, 0.01–0.01), and there was no significant difference compared to normal areas of the study group. There was, however, a significant difference between the control group cartilage and pathologic cartilage of the study group (p < 0.001).ConclusionsElastosonography may be an effective, easily accessible, and relatively simple tool to demonstrate pathologic cartilage and to differentiate it from normal cartilage in the absence of advanced imaging facility such as MRI.Key Points• Elastosonography uses colour-maps and strain ratios for evaluating tissue deformability.• Colour change from blue to red and increased strain ratio represent softening.• Normal cartilage shows decreased compressibility, represented by blue colour and low strain ratio.• Pathologic cartilage shows increased compressibility, represented by red colour and high strain ratio.• Elastosonography may be used for differentiating pathologic cartilage from normal cartilage.

Diminished serum paraoxonase activity in patients with coronary artery calcification

BACKGROUND Previous studies have shown an association between paraoxonase (PON) activity and the presence and severity of coronary atherosclerosis. AIM To demonstrate any association between serum PON activity and the presence and severity of coronary artery calcification (CAC). METHODS A total of 156 consecutive patients having the suspicion of coronary atherosclerosis or needing risk stratification for cardiovascular events were included in the present study. Peripheral venous blood samples of all participants to measure serum PON activity were collected before undergoing multidetector computed tomography, which was used to determine the presence and quantity of CAC. RESULTS Serum PON-1 levels were lower in the CAC group compared to the no CAC group (60 [35-96] U/L vs. 291 [230-371] U/L, respectively, p < 0.001). There was a significant negative correlation between total CAC score and PON (r2 = 0.335, p < 0.001). In multivariate analysis, the significant and independent predictors of the presence of CAC were male sex, high-sensitive C-reactive protein, and PON. Similarly, increased PON was significantly and independently associated with freedom from CAC. In receiver operating characteristics analysis, PON level < 197 U/L had 87% sensitivity, 91% specificity, 93% positive predictive value, and 85% negative predictive value in predicting CAC. CONCLUSIONS Diminished serum PON activity is significantly and independently associated with the presence and severity of CAC, and vice versa.