Nurefsan Boyaci

The Relationship between Quadriceps Thickness, Radiological Staging, and Clinical Parameters in Knee Osteoarthritis.

[Purpose] The aim of this study was to investigate the relationship between clinical parameters, radiological staging and evaluated ultrasound results of quadriceps muscle thickness in knee osteoarthritis. [Subjects] The current study comprised 75 patients (51 female, 24 male) with a mean age of 57.9±5.2 years (range 40–65 years) and a diagnosis of osteoarthritis in both knees. [Methods] Knee radiographs were evaluated according to the Kellgren-Lawrence grading system. Clinical evaluation performed with the visual analog scale (VAS), Western Ontario and McMaster Osteoarthritis Index (WOMAC), the 50-meter walking test, and the 10-step stair test. The thickness of the muscle layer of the quadriceps femoris (M. vastus intermedius and M. rectus femoris) was measured with high-resolution real-time ultrasonography. [Results] The results of this study showed a significant negative correlation between quadriceps thickness and age, duration of disease, stage of knee OA, and VAS, WOMAC, 50-m walking test, and 10-step stair test scores. [Conclusion] The evaluation of quadriceps muscle thickness with ultrasound can be considered a practical and economical method in the diagnosis and follow-up of knee osteoarthritis.

Is There Any Relationship between Joint Destruction and Carotid Intima-media Thickness in Patients with Rheumatoid Arthritis?

[Purpose] The purpose of this study was to investigate the possible relationship between joint destruction and carotid intima-media thickness in patients with rheumatoid arthritis. [Subjects and Methods] Thirty-four RA patients and 31 healthy controls were enrolled in this study. The disease activity for 28 joints was recorded for each patient using the erythrocyte sedimentation rate (DAS28ESR), a visual analog scale (VAS0–10 cm), and a disability index, the health assessment questionnaire (HAQ). X-ray imagesof the patients were scored according to the modified Sharp/van der Heijde method, and the common carotid intimal medial thickness (CIMT) was automatically measured with software using high-resolution Doppler ultrasound. [Results] Contrary to our hypothesis, the modified total Sharp score (mTSS) and CIMT were not significantly associated. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels of the RA patients and the right CIMT, left CIMT, and mean CIMT scores were significantly elevated. Positive correlation was detected between the mean CIMT score and age, CRP levels, LDL concentration and triglycerides (TG) level. In the regression model, where the mean CIMT was the independent variable and age, CRP, LDL, and TG were dependent variables, age was found to be an independent predictor of CIMT. [Conclusions] Patients suffering from RA require close monitoring for cardiovascular risks, and the comorbidity of age-related cardiovascular disease should not be overlooked.

Changes in spastic muscle stiffness after botulinum toxin A injections as part of rehabilitation therapy in patients with spastic cerebral palsy

OBJECTIVE To investigate changes in stiffness in the gastrocnemius (GCM) muscle following rehabilitation therapy and botulinum toxin type A (BTX-A) injections in patients with spastic cerebral palsy (CP). METHODS The study included 16 children with spastic CP (Group 1) and 17 healthy children (Group 2). The children with CP received BTX-A injections and underwent rehabilitation therapy. The GCM and soleus muscles of the CP group were evaluated according to the modified Ashworth scale (MAS). The thicknesses of the muscles were measured, and the elasticity score (ELX 2/1) index was calculated. RESULTS The ELX 2/1 indices of the gastromedialis (GM) and gastrolateralis (GL) were significantly higher in Group 1 than in Group 2 (p < 0.05). The ELX 2/1 indices in the GM and GL muscles in the CP group were found to have decreased 4 weeks after the procedure (p < 0.05). Furthermore, the mean MAS score of the ankle decreased, from 3.4 to 2.6 (p < 0.05). GM ELX 2/1 in Group 1 (post-treatment) was significantly different from Group 2 (p < 0.05). CONCLUSIONS The combined use of clinical scales and sonoelastography can provide valuable information for determining structural changes in the GCM muscle following rehabilitation therapy and BTX-A injections.

Spinal epidural abscess in brucellosis

Involvement of the skeletal system is a common complication of brucellosis. However, muscle involvement or paraspinal abscess formation are rare complications. Paraspinal abscess usually develops secondary to spondylitis. A case is reported here of a 33-year-old woman with symptoms of night sweats, fever and low back pain. Rose-Bengal test for brucellosis was positive and Brucella standard tube agglutination test was positive at a titre of 1/160. The diagnosis was made on MRI. The patient was treated with doxycycline and rifampin daily for 16 weeks. On day 14 of treatment, decline was observed in the patient’s symptoms. In the presence of inflammatory lower back pain and fever, brucellosis should be considered particularly in the endemic areas. Furthermore, tuberculosis should be remembered in the differential diagnosis when a spinal epidural abscess is determined.

Paratracheal air cysts: prevalence and relevance to pulmonary emphysema and bronchiectasis using thoracic multidetector CT

PURPOSE We aimed to determine the prevalence of paratracheal air cysts (PTACs) and the relationship of PTACs with emphysema and bronchiectasis through retrospective analysis of multidetector computed tomography (MDCT) findings. METHODS MDCT findings of 1027 consecutive patients who underwent routine thorax examination between January 2012 and January 2013 were evaluated retrospectively for the presence of PTACs. Localization of the PTACs, as well as their size, shape, and relationship with the trachea were examined. Presence of emphysema and bronchiectasis was recorded, and bronchiectasis severity index was calculated when present. We randomly selected 80 patients who had no visible PTACs as the control group. The findings of patients with and without PTACs were compared. RESULTS PTACs were determined in 82 of 1027 patients (8%), in 8.8% of females and 7.3% of males. The presence of PTACs was determined to be independent of gender (P = 0.361). Eighty-one PTACs (98.8%) were located in the right side of the trachea and 56.1% had a tracheal connection. The presence of PTACs significantly correlated with the presence and severity of bronchiectasis (P = 0.001 and P = 0.005 respectively). There was no significant relationship between the presence of PTACs and the presence of emphysema on CT images (P = 0.125). CONCLUSION The prevalence of PTACs was determined as 8% in this study. There was significant association between PTACs and bronchiectasis.

Primer hydatid cyst of the deltoid muscle

A primary intramuscular hydatid cyst should be considered for the differential diagnosis of cystic soft tissue masses especially in endemic areas, although primary muscular hydatidosis is a rare clinical entity. A case of a 48-year-old male patient with a primary intramuscular hydatid cyst located in the deltoid muscle is reported.

Comparison of the Efficacy of Dry Needling and High-Power Pain Threshold Ultrasound Therapy with Clinical Status and Sonoelastography in Myofascial Pain Syndrome.

ObjectiveThe aim of this study was to compare the therapeutic efficacy of high-power pain threshold (HPPT) ultrasound therapy applied to the trigger points and dry needling (DN) in myofascial pain syndrome. DesignSixty-one patients were randomly assigned to an HPPT (n = 30) and dry needling (n = 31) groups. The primary outcome measures were the Visual Analog Scale (VAS) and Neck Pain and Disability Scale (NPDS), both at 1 week and 4 weeks after treatment. The secondary outcome measures were the number of painful trigger points, range of the tragus-acromioclavicular joint, the Short Form-36, the Beck Depression Inventory, the Beck Anxiety Inventory, and sonoelastographic tests after a 1-week treatment. ResultsMore improvement was seen in anxiety in the HPPT group (P < 0.05). However, no significant differences were found between the groups with regard to other parameters (P > 0.05). A decrease in tissue stiffness was only seen in the HPPT group (P < 0.05). Significant posttreatment improvements were seen on all clinical scales in both groups (P < 0.05). After a treatment period of 4 weeks, a significant improvement was also observed on the visual analog scale and NPDS (P < 0.05). ConclusionsOur study favors the efficacy of both treatment methods in myofascial pain syndrome. Although a significant decrease was shown in tissue stiffness with HPPT, neither of these treatments had an apparent superiority.

A morbid coexistence: thrombosed descending thoracic aorta aneurysm and aortic insufficiency with aortic diastolic reverse flow.

A 76-year-old woman presented with difficulty in speech and weakness on right arm and leg. Her medical history was remarkable only for uncontrolled hypertension for a long period. Dysarthria, right central facial paralysis, right hemiparesis and hypoactive deep tendon reflexes were noticed on neurological examination. Moderate degree aortic insufficiency with aortic diastolic reverse flow was detected on transthoracic echocardiography. Thrombosed aortic aneurysm on descending thoracic aorta, and an acute hemorrhagic infarction in the distribution of the left middle cerebral artery were depicted on thorax, and brain computed tomography scans, respectively. Cerebrovascular event was medically managed and whereas conservative management was offered for thrombosed descending thoracic aorta aneurysm.

Evaluation of left renal vein and inferior vena cava variations through routine abdominal multi-slice computed tomography

BACKGROUND The aim of this study was to evaluate the frequency of left renal vein (LRV) and inferior vena cava (IVC) variations and the effect of gender on this frequency, as well as the presence of associated abdominal pathologies. MATERIALS AND METHODS Multi-slice computed tomography (MSCT) images from 746 patients were evaluated retrospectively. RESULTS Left renal vein variations were identified in 9.8% of cases, while retroaortic LRV (RLRV) and circumaortic LRV (CLRV) were found in 7.4% and 2.4% of cases, respectively. No significant correlation was found between gender and LRV variations (p = 0.797). Of the cases with LRV and IVC variations, 73% had abdominal pathologies, the most common of which were nephrolithiasis, which appeared in 18 (32%) cases, and renal cysts, which appeared in 14 (25.4%) cases. CONCLUSIONS MSCT is a rapid and reliable method of identifying LRV and IVC variations and associated abdominal pathologies.

Colocolonic Intussusception Secondary to Lipoma

BACKGROUND A 44-year-old-woman was admitted to our hospital with a 7-day history of abdominal pain. The pain was non-continuous, generalized and colicky in nature. Physical examination showed diffuse abdominal tenderness. The results of the serum biochemistry tests were within normal limits. Plain film of the abdomen showed a few air-fluid levels.