The correlation between magnetic resonance detected cartilage defects and spiking of tibial tubercles in osteoarthritis of the knee joint.

The aim of the study was to ascertain whether spiking of the tibial tubercle is associated with cartilage defects detected by magnetic resonance imaging (MRI) in patients with osteoarthritis (OA) of the knee joint. Angulation of the tip of the medial and lateral tubercles, and the height of the tubercles above the tibial plateau were measured on a standard anteroposterior radiograph of the knee joint. Cartilage defects in the tibiofemoral joint (TFJ) were determined by MRI examination. The lengthening and sharpening of the angles of the tubercles were significantly more prominent in the patients than controls. A strong association was found between angulation (if less than 70 degrees) and especially the height (if more than 0.16) of the medial tibial spike and MRI-detected cartilage defects in the medial tibiofemoral compartment. The predictive value of the spiking of tibial tubercles for MRI-detected cartilage defects in TFJ is related to the degree and size of the spiking. The presence of tibial spiking itself may not be a reliable sign of early OA

Injury to the lacrimal apparatus after endoscopic sinus surgery: Surgical implications from active transport dacryocystography

In order to evaluate the lacrimal drainage system injury after functional endoscopic sinus surgery, surgical records and postoperative active transport dacryocystography imaging of 31 patients were analyzed. Presence of the lacrimal bone dehiscence and no passage of the contrast material into the inferior meatus were noted as the signs of injury to the lacrimal canal on active transport dacryocystography. Bony dehiscence was detected in 53.2% of the operated sides but 20% of the nonoperated sides. No passage of the contrast material into the inferior meatus was observed in 14.9% of the operated sides. There were no cases of epiphora postoperatively. The lacrimal drainage system injury was more frequently observed on the left sides operated. We conclude that lacrimal drainage system injury might occur in various extents during functional endoscopic sinus surgery. However, it does not necessarily result in postoperative epiphora. Performing the middle meatal antrostomy in posteroinferior direction, and uncinectomy with backbiting forceps or a shaver might help in reducing the lacrimal injury. Active transport dacryocystography can be adopted as an alternative diagnostic tool in detection of the lacrimal injury. (Otolaryngol Head Neck Surg 2001;124:308-12.) Functional endoscopic sinus surgery (FESS) has gained popularity among otorhinolaryngologists since its first introduction in mid-70s. The primary reason is probably that it enables direct visualization of intranasal anatomic structures and pathologies. Although the procedure seems to be easy to perform, it is indeed a delicate operation, and surgical injury to the neighboring structures does still occur. Various important complications such as cerebrospinal fluid leak and blindness have been reported following FESS. 1 Nevertheless, lacrimal injury is frequently overlooked. Lacrimal drainage system (LDS) is one of the most vulnerable structures to the surgical trauma in the course of FESS due to its intimate anatomic localization. Epiphora after LDS injury has been reported to range from 0.3 to 1.7%. 2-4 However, LDS injury does not necessarily result in epiphora. Asymptomatic cases, which had the intraoperative occult damage, have also been reported in 15% of the patients undergoing endoscopic ethmoidectomies. 3 Therefore, assessing the anatomic integrity and function of the LDS is important. Several methods have been used for evaluation of the LDS. METHODS AND MATERIALS In order to examine the degree and type of possible injury to the LDS, 31 patients who underwent FESS at the otorhinolaryngology department of Celal Bayar University School of Medicine in Manisa, Turkey, were postoperatively evaluated with ATD. Clinical records regarding the age and gender of the patients, diagnosis, type of operation, and surgical findings as well as the period between the operation and ATD evaluation were retrospectively analyzed. Patients who had preoperative epiphora or previous dacryocystorhinostomy operation were excluded from the study. The parameters studied on ATD examination for the evaluation of the LDS injury were the integrity of the bony lacrimal canal and its patency, which was indicated by observation of the nonionic contrast material in the inferior meatus. Operative and ATD findings were analyzed separately on the left and right sides in each patient. In unilateral cases, ATD findings on the nonoperated side were also recorded as a control group. The side differences in all surgical interventions and differences in findings between the operated and the nonoperated sides in unilateral cases were statistically analyzed. A t test was used in statistical analysis for the comparison of the percentages. All patients were operated on using the technique of FESS described by Stammberger 1 and Kennedy et a

The osteoarthritis of the atlanto-odontoid joint

Bu çalışmada, atlanto-odontoid (AO) eklemin bilgisayarlı tomografi (BT) ile değerlendirimi ve osteoratrite ait morfolojik değişikliklerin yaşa göre dağılımlarının belirlenmesi amaçlandı. ÂO eklemde osteoartrite ait patolojik bulgular osteofitler, eklem aralığında daralma ve transvers ligament kalsifikasyonu olarak gruplandınldı. Olguların %75'inde AO eklemde osteoartrite ilişkin morfolojik değişiklikler olup en sık bulgu eklem aralığında daralma idi (%64). Osteoartrit prevalansı yaşla artıyordu. Sonuç olarak, suboksipital bölgede lokalize semptomların ayırıcı tanı ve tedavisinde AO eklemde osteoartrit göz önünde bulundurulmalıdır ve BT eklemi değerlendirmede en değerli görüntüleme aracıdır.The aim of this study was to evaluate the atlanto-odontoid (AO) joint using computed tomography (CT) and to determine age specificity of various morphologic changes related to osteoarthritis: Pathologic findings related to AO osteoarthritis were categorized into three groups as; osteophytosis, obliteration of the joint space and transverse ligament calcification. Morphologic changes related to AO osteoarthritis were found 75% of the cases and in CT evaluation obliteration of the joint space was found the most frequently (64%). The prevalance of the AO joint osteoarthritis was increasing with age. In conclusion, AO joint osteoarthritis must be considered in establishing the diagnosis and in planning the treatment modality of the suboccipital region symptoms. And in evaluating of the AO joint CT imaging is the most valuable method

Barium sulphate allergy

Baryum sülfat gastrointestinal sistem (GİS) incelemelerinde yaygın olarak kullanılmakta ve güvenli bir kontrast madde olarak kabul edilmektedir. Baryum sülfat inerttir ve sağlam mukozadan emilmez. Baryum sülfata karşı allejik reaksiyon çok nadirdir. Bu çalışmada üst GİS incelemesi sırasında baryum sülfat allerjisi gelişen bir olgu nadir olması nedeniyle sunulmaktadır.Barium sulphate is a commonly used agent in the radiographic studies of the gastrointestinal tract and has been regarded as a safe contrast medium. Barium sulphate allergy is very rare. We present a case of barium sulphate allergy which occurred during an upper gastrointestinal study in a 24-year-old woman

Lateral Epikondilitli Hastalarda Ultrasonografinin Tanı ve Ağrı ve Kavrama Gücü Değerlendirmesinde Önemi

Amaç: Lateral epikondilit (LE) esasen klinik olarak tanınır. Ultrasonografi (US) LE'nin şiddeti, boyutu ve yerleşimi hakkında yararlı bilgi sağlayabilir. Amaç, LE'nin doğrulanması için US'nin kullanılması ve bu hastalarda ağrı, kavrama gücü, fizik bakı ve engellilik arasındaki ilişkileri incelemekti.Yöntem ve Gereçler: Unilateral LE'li 52 hasta US ile incelendi. Ağrı ve fonksiyonel durum görsel analog ölçütü, Yaşam Kalitesi Short Form-36 (SF-36), patient-rated forearm evaluation questionnaire (PRFEQ) kullanılarak belirlendi. Kavrama gücü ve LE için manüel testler değerlendirildi.Bulgular: Hastaların 28'inde (%53.8) LE'nin klinik tanısı US ile doğrulandı. Sonuçlarımız sonografisi anormal hastalarda, klinik muayene bulgularıyla SF-36 ve PRFEQ ağrı değerlendirmeleri arasında yakın ilişkiyi gösterdi. Bu hastalarda kavrama gücüyle de klinik ve fonksiyonel değerlendirmeler arasında karşılıklı ilişki vardı.Sonuç: LE'de engellilik değerlendirmesinde geleneksel klinik muayeneden başka yöntemlere ihtiyaç olduğu kanısına vardık. LE'nin sonografik bulguları olan hastalarda, ağrı ve kavrama gücü ölçümleri şiddet ve engelliğin değerlendirilmesinde sayısal ve nicel bilgi verir.Objective: Lateral epicondylitis (LE) is generally diagnosed clinically. Ultrasonography (US) can provide useful information about the location, extent, and severity of LE. Our objective was to use US to confirm LE and to investigate the relationships between pain, grip strength, physical examination, and disability in these patients.Material and Methods: Fifty-two patients with unilateral LE were examined by US. Pain and functional status were assessed using a visual analog scale (VAS), physical functioning and bodily pain scales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and a patient-rated forearm evaluation questionnaire (PRFEQ). Grip strength and manual tests for LE were evaluated.Results: Clinical diagnosis of LE was confirmed by US in 28 (53.8%) patients. Our results showed close associations between clinical examination findings and SF-36 and PRFEQ assessments with pain in patients who had sonographic abnormalities. Grip strength was also correlated with clinical and functional evaluations in these cases. Conclusion: We concluded that evaluation of disability in LE requires methods different from those included in the traditional clinical examination. Pain and grip strength measurements provide numerical and quantitative data for evaluation of severity and disability in patients with sonographic findings of LE

Pubovajinal sling operasyonu sonrası inkontinans şiddet indeksi ile MRG bulgularının karşılaştırılması

Amaç: Bu çalışmanın amacı pubovajinal sling operasyonu ile tedavi edilen hastalarda postoperatif MRG bulguları ile inkontinans şiddet indeksi arasındaki ilişkiyi araştırmaktır. Yöntem ve gereç: Pubovajinal sling operasyonu geçirmiş 52 kadın hasta çalışmaya dahil edildi. Postoperatif altıncı ayda hastaların inkontinans şiddet indeksleri değerlendirildi. Aynı gün hastaların MRG incelemeleri de yapıldı. Hastalardan istirahatta ve maksimum ıkınma sırasında simfisis, üretra ve koksiksi de içerecek şekilde T2-A sagittal görüntüler elde edildi. Her hasta için mesane tabanının mobilitesi ve posterior üretrovezikal açı değişiklikleri hesaplandı. İnkontinans şiddet indeksi ile mesane tabanı mobilitesi ve posterior üretrovezikal açı değişiklikleri arasındaki ilişki SPSS programı ile Sperman's Rho korelasyon testi kullanılarak analiz edildi. Bulgular: İnkontinans şiddet indeksi ile mesane boynu mobilitesi arasında ve şiddet indeksi ile posterior üretrovezikal açının derecesi arasında pozitif korelasyon saptandı (sırasıyla, r = 0,797, P = 0,000; r = 0,62, P = 0,000). Valsalva manevrası sırasında posterior üretrovezikal açıdaki artış ile inkontinans şiddet indeksi arasında da pozitif korelasyon görüldü (r = 0,47, P = 0,02). Sonuç: MRG stres üriner inkontinanslı hastalarda mesane tabanının pozisyonunun, mesane boynu mobilitesinin ve posterior üretrovezikal açının değerlendirilmesinde noninvaziv bir tanı yöntemidir. Stres üriner inkontinansın postoperatif takibinde önemli rol oynayabilir. MRG pubovajinal sling cerrahisinin başarısının değerlendirilmesinde de kullanılabilir.Aim: To investigate the relationship between postoperative MRI findings and the severity score of incontinence in patients treated with pubovaginal sling surgery. Materials and methods: Fifty-two female patients treated with pubovaginal slings were included in the study. These patients’ severity scores of incontinence were evaluated in the postoperative 6 th month. All the patients were examined using MRI on the same day. A T2-weighted sagittal image of the midline structures, including the symphysis, urethra, and coccyx, was obtained at rest and at maximal strain. The mobility of the bladder floor and change in the posterior urethrovesical angle were calculated for each patient. Relationships between the severity score of incontinence and mobility of the bladder floor and change in the posterior urethrovesical angle were analyzed using Spearman's rank correlation coefficients by means of SPSS. Results: A positive correlation was found between the severity score of incontinence and the mobility of the bladder neck and also between the score and the degree of posterior urethrovesical angle (r = 0.797, P = 0.000; r = 0.62, P = 0.000, respectively). There was also a positive correlation between the severity score of incontinence and the increase in posterior urethrovesical angle during Valsalva's maneuver (r = 0.47, P = 0.02). Conclusion:MRI is a non-invasive diagnostic method for the evaluation of bladder floor position, mobility of the bladder neck, and posterior urethrovesical angle in patients with stress urinary incontinence. It can play a major role in the postoperative follow up of stress urinary incontinence. MRI can also be used for the assessment of success in pubovaginal sling surgery

Diagnosis of acute cholecystitis with power Doppler us: Comparison of sonography-pathology

Power Doppler ultrasonografi nispeten hız ve açıdan bağımsız, küçük vasküler yapıları ve yavaş akımları göstermede renkli Doppler ultrasonografiden üstün yeni bir Doppler inceleme yöntemidir. Bu çalışmadaki amaç; power Doppler ultrasonografinin akut kolesistitin tanısına ve kronik kolesistit He ayırıcı tanısına katkılarını araştırmaktır. Sağ üst kadran ağrısı şikayeti olan veya klinik olarak kolesistit olduğu düşünülen 120 hastada konvansiyonel gri skala ultrasonografiye ilave olarak renkli Doppler ultrasonografi ve Power Doppler ultrasonografi He safra kesesi duvar kanlanması incelendi. Bunlardan öpere edilen 48 hastanın sonografi bulguları ile histopatolojik bulguları karşılaştırıldı. Histopatolojik olarak öpere edilen 48 hastanın 23'ünde akut kolesistit, 25'inde kronik kolesistit saptandı. Power Doppler ultrasonografi ile akut kolesistitli 23 hastanın 22'sinde (% 95) safra kesesi duvarında hipervaskülarite saptandı. Akut kolesistitin tanısında power Doppler ultrasonografinin sensitivitesi %95 ve spesifisitesi %100 idi. Sonuç olarak Power Doppler ultrasonografi akut kolesistitli hastaların tanısında ve kronik kolesistitden ayrımında oldukça duyarlı bir yöntemdir. Kolesistitten şüphelenilen hastalarda gri skala ultrasonografinin tanısal değerini arttırmak için rutin olarak kullanılmalıdır.Power Doppler ultrasonography is a new Doppler examination technique which is relatively independent from flow and angle, and it is superior to color Doppler ultrasonography to display small vessels and slow lows. The aim of this study was to investigate the role of Power Doppler ultrasonography in diagnosing acute cholecystitis and differentiating acute from chronic cholecystitis. In one hundred twenty patients with acute right upper quadrant pain or clinically suspected cholecystitis, gallbladder wall vascularity underwent color Doppler ultrasonography and Power Doppler ultrasonography as an adjunct to gray-scaleultrasonography. Imaging findings were compared with pathologic findings in the 48 patients who underwent cholecystectomy. In histopathologic examinations of the operated 48 patients, 23 patients had acute cholecystitis, 25 patients had chronic cholecystitis. With power Doppler ultrasonography, 22 (95%) of 23 patients with acute cholecystitis had hypervascularity in gallbladder wall. Sensitivity and specificity of Power Doppler ultrasonography for revealing acute cholecystitis were 95% and 100%, respectively. As a result, Power Doppler ultrasonography is a very sensitive method for diagnosing acute cholecystitis and differentiating it from chronic cholecystitis. It should be routinely performed in patients with suspected cholecystitis to improve the diagnostic capabilities of gray-scale ultrasonography

The lesions of basal ganglion in methanol poisoning: CT findings

Daha önce sağlıklı 21 yaşında erkek hasta 200-300 ml kaçak kolonya içtikten bir gün sonra halsizlik, bulantı, kusma, karın ağrısı ve görme bozukluğu şikayetleri ile acil servise müracaat etmiş. Metil alkol entoksikasyonu düşünülen hastanın oftalmik muayenesinde; her iki gözde ışık hissi negatif, pupillalar dilate, papilla ve çevresi ile büyük damarlar boyunca sinir lifleri katı ödemi gözlendi. Çektirilen beyin tomografisinde; bilateral simetrik putaminal nekroz ve her iki frontal lobta subkortikal nekrotik alanlar mevcuttu. Bu makalede çok ciddi sonuçları olan bu entoksikasyonun erken dönemde tanınıp doğru ve hızlı tedavisinin yapılabilmesi için oftalmologlar kadar acil servis hekimleri ve radyologlara da önemli sorumluluk düştüğü vurgulanmıştır.A 21-year old man, previously in good health, ingested about 200-300 ml of illicit cologne and was brought to emergency department of hospital one day after ingestion. Symptoms were as follows: weakness, nausea, vomiting, abdominal pain and visual disturbances. On ophthalmic examination of the patient who was considered of methanol intoxication, negative light perception in both eyes, dilated pupils, edema of the disc and adjacent retina and of nerve fiber layer with along the course of major retinal vessels were observed. Bilateral symmetric putaminal necrosis and necrotic areas in the frontal lobs were seen on computed tomography. In this report, We have emphasized that emergency's doctor and radiologists are also responsible as well as ophthalmologists, because this intoxication with severe results should be treated truly and quickly in the early phase

Radikülopatili olguların lumbosakral bölge BT bulguları ve nöral kanal çaplarının normal olgularla karşılaştırılması

BT ile L3-L4, L4-L5 ve L5-51 disk aralıklarını incelediğimiz 200 radikülopatili olguda; disk hernilerinin x 51.62 oranında L4-L5 ve % 40 oranında L5-S1 seviyesinde olmak üzere % 91.62 oranında L4-L5 ve L5-51, % 8.38 oranında L3-L4 disk aralığında görül düğünü ve hernilerin % 61.93 oranında posterolateral, % 32.26 oranında santral ve % 5.80 oranında lateral lokalizasyon gösterdiğini, bulginglerin ise X 77.77 oranında L4-L5 disk aralığında bulunduğunu ve radikülopatinin orta yaşlarda sık olduğunu saptadık. Bu olgularımızın nöral kanal ölçümlerini kontrol grubu olarak aldığımız 40 normal olgu ile karşılaştırdığımızda; radikülopatililerde nöral kanal değerlerinin anlamlı derecede dar olduğunu ve buna bağlı olarak dural kese ve kök basısı olasılığının daha fazla olduğunu gördük. Radikülopatili grupta ve kontrol grubunda kadınlarla erkeklerin nöral kanal ölçümlerinin mukayesesini yaptığımızda; cinsler arasında anlamlı bir fark olmadığını ortaya koyduk

Interaction between C-Reactive Protein and Endothelin-1 in Coronary Artery Disease

Background: Increased concentrations of serum C-reactive protein (CRP) have been reported to predict major cardiovascular events in patients with coronary artery disease (CAD). Increased concentrations of endothelin-1 (ET-1) are also associated with poor prognosis after myocardial infarction. Hypothesis: We tested the hypothesis that ET-1 might contribute to CRP in prediction of adverse outcome in CAD. Methods: Serum high sensitive CRP and plasma ET-1 levels of 40 patients who have stable CAD and 25 control subjects were measured, and correlation analysis between these molecules was performed. Results: Mean high sensitive CRP was 8.64 +/- 12.73 mg/l, and mean ET-1 was 8.24 +/- 7.06 pg/ml in the CAD group. We found that there was no statistically significant correlation between high sensitive CRP and ET-1 in either CAD group (p = 0.82), or the control group (p = 0.85). In a subgroup of 13 patients who were not under statin treatment, we found a strong correlation between the levels of these molecules (p = 0.01). Conclusion: Our study does not clearly support or exclude a link between CRP and ET-1 in patients who have stable CAD. Copyright (C) 2007 S. Karger AG, Base