Clinical presentations and diagnostic work-up in sarcoidosis: A series of Turkish cases (clinics and diagnosis of sarcoidosis)

Sarcoidosis is an idiopathic granulomatous disease. It usually affects the lung. The diagnosis may be problematic since the known causes of granulomatous inflammation must be excluded. This multicenter study aimed to evaluate the clinical presentations and diagnostic approaches of sarcoidosis. The study protocol was sent via internet, and the participants were asked to send the information (clinical, radiological and diagnostic) on newly diagnosed sarcoidosis cases. 293 patients were enrolled within two years. Pulmonary symptoms were found in 73.3% of the patients, and cough was the most common one (53.2%), followed by dyspnea (40.3%). Constitutional symptoms were occured in half of the patients. The most common one was fatigue (38.6%). The most common physical sign was eritema nodosum (17.1%). The most common chest radiograhical sign was bilateral hilar lymphadenomegaly (78.8%). Staging according to chest X-ray has revealed that most of the patients were in Stage I and Stage II (51.9% and 31.7%, respectively). Sarcoidosis was confirmed histopathologically in 265 (90.4%) patients. Although one-third of the bronchoscopy was revealed normal, mucosal hyperemi (19.8%) and external compression of the bronchial wall (16.8%) were common abnormal findings. The 100% success rate was obtained in mediastinoscopy among the frequently used sampling methods. Transbronchial biopsy was the most frequently used method with 48.8% success rate. Considering sarcoidosis with its most common and also rare findings in the differential diagnosis, organizing the related procedures according to the possibly effected areas, and the expertise of the team would favor multimodality diagnosis

Rib deformity in scoliosis

Rib deformity in scoliosis is of interest because it may help in the diagnosis, and also, in some pronounced cases, it may need correction by costoplasty. There are, however, debates about its use in diagnosis, because some authors think that rib deformity is not closely related to either the magnitude or the extent of rotation of the curve. In order to define the relation between rib deformity and scoliosis, 11 patients were recruited who were to undergo scoliosis surgery and thoracoplasty, and anteroposterior (AP) T1-S1 standing radiographs, computerized tomography (CT) scans, and three-dimensional (3D) reconstructions were obtained. From the radiographs, the most rotated vertebra, the Cobb angle, the apex and the type of the curve were determined. From the CT scans and 3D reconstructions, the exact level of the rib deformity measured was matched with the corresponding vertebral level. In this way, the most rotated vertebra and the most prominent part of the rib cage deformity were identified. The most rotated vertebra was found to be at the same level in both radiographs and CT scans in only five patients. In the rest of the patients, CT scans showed it either one level higher or lower than it appeared on the radiograph. The most prominent part of the rib cage deformity was at the same level as the most rotated vertebra in two patients, and in the rest of the patients it was one, two or three vertebral levels lower. There was no association between the Cobb angle, vertebral rotation and rib deformity. ACT scan is necessary preoperatively in patients who will undergo a costoplasty, to determine the exact levels of the prominence. However, a scanogram or a 3D reconstruction is required for exactly matching the most prominent part of the rib cage deformity to the corresponding vertebral level

The effect of percutaneous trigger finger release on normal anatomic structures and long-term results of the procedure

OBJECTIVES: To evaluate the long-term results and possible complications of percutaneous release in the treatment of trigger finger. METHODS: We performed percutaneous pulley release with the use of a 16 gauge needle in 25 fingers of 22 patients (16 females, 6 males; mean age 54 years; range 45 to 72 years). Open exploration was added to the procedure in 10 patients to determine the efficacy and safety of the technique. The mean follow-up was 24 months (range 18 to 35 months). RESULTS: Triggering and pain were eliminated in all fingers postoperatively. Exploration showed that a complete anatomical release of the pulley was obtained in all fingers. Apart from some superficial abrasions, there were no tendinous injury or other complications. In one case, an unintentional skin incision occurred during manipulation of the needle. CONCLUSION: Due to low complication rates and ease of the procedure with a successful release, percutaneous technique proved an appropriate alternative in the treatment of trigger finger

The acetabular teardrop and ultrasonography of the hip

The acetabular teardrop is an important tool for the diagnosis of acetabular dysplasia. Since it was first described by Köhler its widespread use has not become established due to the relative subjectivity in classification of the types. The acetabular teardrop angle (ATA) is proposed for this purpose, and to show the teardrop's direct relation to acetabular development by correlating it with hip ultrasonography results. Patients (51 male, 53 female) included in this study received hip ultrasonography and concomitant pelvic radiography. In the 296 hips, α and β angles were measured from ultrasonography, whilst the acetabular index (AI), ATA, teardrop distance and the transverse diameter of the most upper, most widened part of the teardrop were measured from the radiographs. The enlarged, and triangle-shaped teardrop is seen later than normal ones, and the triangle-shaped-teardrop hips have a higher AI than the normal hips. The ATA is in good correlation with the widest diameter, showing this to be a reliable tool for describing the teardrop. The ATA also has a positive correlation with the β angle denoting its significance to acetabular development. High-risk babies should be followed-up primarily with ultrasonography wherever possible. The Al from radiographs and the acetabular teardrop may be used as a helper tools in decision-making, with the guides of the ATA and the transverse diameter of the most upper, most widened part of the teardrop, as proposed in this study. © 2004 Lippincott Williams & Wilkins

Middle-term therapeutic effect of the sacroiliac joint blockade in patients with lumbosacral fusion-related sacroiliac pain

Objective: The aim of this study was to compare the therapeutic effect of sacroiliac (SI) blockade in patients with and without lumbosacral fusion. Methods: This study included 72 patients diagnosed with SI pain and who received blockade injection (methylprednisolone and lidocaine). Patients were divided into 2 groups; 22 patients in the fusion group who underwent previous lumbosacral fusion and 50 patients in the non-fusion group. Average follow-up was 17.7 (range: 6 to 30) months. All patients were evaluated before and after intervention using the Visual Analog Scale (VAS), Oswestry Disability Index, Rivermead Mobility Index and SF- 36. Results were statistically analyzed. Results: Activity pain (a component of VAS) was significantly better in the non-fusion group than the fusion group (p=0.042). No other statistically significant differences were observed between groups (p>0.05). Conclusion: Sacroiliac blockade has a similar therapeutic effect on patients who underwent lumbosacral fusion surgery as on non-operated patients in the middle-term. Therefore, alternative treatment options are not necessary in patients with fusion. © 2014 Turkish Association of Orthopaedics and Traumatology

Is quality of life related to risk of falling, fear of falling, and functional status in patients with hip arthroplasty?

Objective: The aim of the study was to investigate the relation between health-related quality of life and risk of falling, fear of falling, and functional status in patients with hip arthroplasty. Methods: In this cross-sectional study, 48 hips of 45 patients who aged between 33 and 79 (53.56 ± 12.50) years and had cementless total hip arthroplasty between 2010 and 2014 were evaluated. Twenty-seven of the patients participated in the study were female (60.0%) and 18 were male (40.0%). Health-related quality of life with Nottingham Health Profile, function of the hip joint with Harris Hip Score, risk of falling with Performance-Oriented Motion Assessment I, and fear of falling with Falls Efficacy Scale were assessed. In addition, chair stand test, 40-m walk test, stair-climb test, and single leg stance test were carried out. In analysing the relationships between these parameters, Pearson correlation analysis was employed. The level of significance was considered as p < 0.05. Results: Among the cases, who were evaluated 87.10 ± 45.22 (22.43–214.71) weeks after the operation, a significant correlation was found between health-related quality of life and risk of falling, function of hip joint, and functional tests (p < 0.05). Conclusion: The evaluation of the factors related to health-related quality of life in hip arthroplasty patients may help identify patient needs and guide the rehabilitation process. © 2019 John Wiley & Sons, Ltd