Charcot Foot In Diabetes And An Update On Imaging

Charcot neuroarthropathy (CN) is a serious complication of diabetes mellitus that can cause major morbidity including limb amputation. Since it was first described in 1883, and attributed to diabetes mellitus in 1936, the diagnosis of CN has been very challenging even for the experienced practitioners. Imaging plays a central role in the early and accurate diagnosis of CN, and in distinction of CN from osteomyelitis. Conventional radiography, computed tomography, nuclear medicine scintigraphy, magnetic resonance imaging, and positron emission tomography are the imaging techniques currently in use for the evaluation of CN but modalities other than magnetic resonance imaging appeared to be complementary. This study focuses on imaging findings of acute and chronic neuropathic osteoarthropathy in diabetes and discrimination of infected vs. non-infected neuropathic osteoarthropathy

Ct Assessment Of Asymptomatic Hip Joints For The Background Of Femoroacetabular Impingement Morphology

PURPOSE The purposes of this study were to assess the presence of cam and pincer morphology in asymptomatic individuals with a negative femoroacetabular impingement test, and to determine and compare the ranges of alpha angle using two measurement methods. MATERIALS AND METHODS In total, 68 consecutive patients who underwent abdominopelvic computed tomography (CT) for reasons other than hip problems were the patient population. Patients who had a positive femoroacetabular impingement test were excluded. Alpha angle measurements from axial oblique (A(N)) and radial reformat-based images (A(R)) from the anterior through the superior portion of the femoral head-neck junction, as well as femoral head-neck offset, center-edge angle, acetabular version angle measurements, and acetabular crossover sign assessment, were made. RESULTS Overall prevalences of cam (increased alpha angle, decreased femoral head-neck offset) and pincer morphology (increased center-edge angle, decreased acetabular version) were 20.0%, 26.8%, 25.8%, and 10.2% of the hips, respectively. The mean A(R) ranged from 41.64 degrees +/- 4.23 degrees to 48.13 degrees +/- 4.63 degrees, whereas A(N) was 41.10 degrees +/- 4.44 degrees. The values of A(R) were higher than A(N), and the difference was statistically significant (P < 0.001). The highest A(R) values were measured on images from the anterosuperior section of femoral head-neck junction. CONCLUSION In asymptomatic subjects, higher alpha angle values were obtained from radial reformatted images, specifically from the anterosuperior portion of the femoral head-neck junction compared with the axial oblique CT images. Other measurements used for the assessment of cam and pincer morphology can also be beyond the ranges that are considered normal in the general population.WoSScopu

Effect of Total versus Partial Assisted Hatching on the Clinical Pregnancy Rates in Assisted Reproduction Technology

Objective: The objective of this study was to investigate the effect of total or partial assisted hatching on the clinical pregnancy rates in assisted reproduction technology. Study Design: This was a case-control study conducted from the beginning of January 2016 to the end of June 2017. A total of 404 cycles were included in this case-control study. Study population was divided into 3 groups: Group 1: Partial assisted hatching (n=118), Group 2: Total assisted hatching (n=81) and Control group (n=205). Results: In women of all ages, clinical pregnancy rates were similar between groups with total or partial assisted hatching compared to control group (p>0.05). The rates were also similar in subgroups of women with blastocyst or cleavage stage embryo transfers (p>0.05). Partial or total embryo hatching did not result in favorable outcome compared to control group either in women over 35 or younger than 35 years of age (p>0.05). In whole study group pregnancy rate was significantly higher in group with blastocyst stage embryo transfers (22.4 % versus 48.8%, p<0.05) Conclusion: Partial or total assisted hatching do not have any impact on the clinical pregnancy rates, no significant impact was determined in subgroup of women either

Short Term Alterations of Hormone Profile Following Oocyte Pick-Up in Women with Polycystic Ovarian Syndrome to Assess the Effect of Multiple Needle Entries Into the Ovarian Cortex and Stroma

Objective: Some hormonal alterations after ovarian diathermy have been proposed in previous studies. Based on this data, we aimed to analyze some hormone profile changes following oocyte pick-up in women with polycystic ovarian syndrome. Study Designs: A total of 50 women with polycystic ovarian syndrome underwent ovarian stimulation for IVF cycle with an indication of anovulatory infertility. Some hormone profiles with the insulin resistance were assessed before and after oocyte pick-up to (early in the morning before starting stimulation and repeated 1 month later from oocyte pick-up day) assess whether high number of needle entries into the ovarian cortex and stroma result in similar effect with the diathermy. Results: Comparison of some variables revealed significantly decreased HOMA-IR and serum total testosterone concentrations after intervention. Correlation analyses showed significant correlations between number of needle entries, change in HOMA-IR, baseline total testosterone level and change in AMH level. Conclusion: Our data showed significant metabolic and hormonal alterations following oocyte pick up consistent with the effect of ovarian diathermy in women with polycystic ovarian syndrome

Does the Modification of Starting Gonadotropin Dose During ICSI Cycle Have Any Significant Impact on Cycle Outcome?

OBJECTIVE: The aim of this study was to figure out the impact of gonadotropin dose alteration requirements due to high response or unresponsiveness on intracytoplasmic sperm injection cycle outcomes in a standard group of patients. STUDY DESIGN: One hundred cycles with same gonadotropin dosage along the stimulation were compared with 100 cycles in which gonadotropin dose alterations were needed due to high response or unresponsiveness. Groups were compared in terms of age, body mass index, serum follicle stimulating hormone and estradiol levels, antral follicle count, gonadotropin dosage, duration of stimulation, endometrial thickness at trigger day, number of total, mature and immature oocytes and finally the clinical pregnancy rates. RESULTS: There were significant differences between groups with regard to gonadotropin starting dose, total gonadotropin dose, duration of stimulation, estradiol level at trigger day, number of total oocytes and metaphase 1 oocyte number. Clinical pregnancy rates were similar between groups. CONCLUSION: Dose alteration requirement along intracytoplasmic sperm injection cycle result in high number of total and metaphase 1 oocyte yields, higher starting gonadotropin and total gonadotropin dose, duration of stimulation and estradiol level at trigger day, however clinical pregnancy rates were similar between groups