The co-occurrence of calcaneal spur and hallux valgus: A radiological evaluation

BACKGROUND

Calcaneal spur and hallux valgus are common foot deformities and both conditions have been shown to disrupt foot biomechanics.

OBJECTIVES

This study aimed to investigate the association between calcaneal spur and hallux valgus using radiographic and demographic data.

METHODS

A total of 1375 patients (1083 women; mean age: 45.5 years) with standard ankle lateral and foot conventional anteroposterior radiographs were evaluated. The following data were obtained: age, gender, laterality, hallux valgus angle (HVA), intermetatarsal angle (IMA), and calcaneal spur. Patients with a HVA of 15∘ and above were considered to have hallux valgus. Patients with hallux valgus were classified into three different groups according to the HVA.

RESULTS

The prevalence of calcaneal spur was higher in older age and women (45.8%, 30.2%; p< 0.01, p< 0.01, respectively). Subjects with and without calcaneal spurs had similarities in terms of their laterality, having a HVA of ⩾ 15∘ and an IMA of ⩾ 11∘ (p> 0.05). Hallux valgus severity was not associated with calcaneal spur (p> 0.05). In addition, the hallux valgus prevalence was higher in patients who were over 50 years old (58.2%, p= 0.046).

CONCLUSIONS

The presence of calcaneal spurs does not affect the prevalence of hallux valgus. The severity of hallux valgus determined according to the HVA was similar in patients with and without calcaneal spurs. In addition, female gender and older age were identified as risk factors for calcaneal spurs, while only older age was a risk factor for hallux valgus.

Is there a relation between plantar fasciitis and total cholesterol levels?

BACKGROUND

The main objective of this study is to investigate the relationship between hypercholesterolemia and Plantar Fasciitis (PF).

METHODS

The study includes patients who presented to the orthopedics outpatient clinic with heel pain and were diagnosed with PF. The control group was composed of patients who came to the orthopedics outpatient clinic, with complaints other than heel pain. The two groups were compared in terms of epidemiological data, total cholesterol (TC) levels, and hypercholesterolemia prevalence. We also performed an in-group analysis of PF patients in terms of age, sex, body mass index, and duration of symptoms.

RESULTS

There were 238 patients (mean age, 46.7) in the PF group and 240 patients (mean age, 47.9) in the control group. There was a significant difference between the PF group and the control group in TC levels (207.6 ± 47.5 versus 195.1 ± 30.1, p = 0.001). Hypercholesterolemia (TC level > 240 mg/dL) was found in 22.7% (n = 54) of the patients in the PF group whereas in the control group this rate was 10.8% (n = 26) (p < 0.001). It was seen that the TC levels were significantly higher in patients over the age of 45 in the PF group (p = 0.038). We also found that TC levels were higher in PF patients with symptoms for longer than a year (p = 0.026).

CONCLUSION

Significantly higher TC levels were found in PF patients in comparison with other orthopedic outpatients. Besides, being over the age of 45 and having a duration of symptoms longer than a year is associated with higher cholesterol levels for PF patients.

LEVEL OF CLINICAL EVIDENCE

4.

Children with supracondylar humerus fractures have an increased risk of attention deficit hyperactivity disorder

Children with attention deficit hyperactivity disorder (ADHD) have an increased risk of sustaining fractures during their preschool years. Supracondylar humerus fractures (SHFs) comprise the majority of fracture surgeries in the pediatric age range. We hypothesized that ADHD symptoms would be present in children with SHFs, and this characteristic trauma may be associated with an ADHD diagnosis. Thus, we compared the ADHD symptoms of children with and without SHFs. Further, we compared the trauma characteristics, gender, proneness to injury, and presence of prior trauma history of children diagnosed with and without ADHD. We recruited 41 children who were admitted to emergency service with an SHF and 41 age- and gender-matched children without a fracture history. A semi-structured diagnostic inter- view and a Swanson Nolan Pelham questionnaire were used to obtain data about ADHD symptoms. A clinical intake form was utilized for further clinical data. ADHD symptoms were significantly higher in the fracture group ; male gender, parent- reported proneness to injury, and prior history of trauma were significantly associated with ADHD. Orthopedic surgeons may provide early detection of ADHD by using screening tools or asking questions to caregivers and making referrals when needed. This may lead to prevention of further injuries.

Children with supracondylar humerus fractures have an increased risk of attention deficit hyperactivity disorder

Children with attention deficit hyperactivity disorder (ADHD) have an increased risk of sustaining fractures during their preschool years. Supracondylar humerus fractures (SHFs) comprise the majority of fracture surgeries in the pediatric age range. We hypothesized that ADHD symptoms would be present in children with SHFs, and this characteristic trauma may be associated with an ADHD diagnosis. Thus, we compared the ADHD symptoms of children with and without SHFs. Further, we compared the trauma characteristics, gender, proneness to injury, and presence of prior trauma history of children diagnosed with and without ADHD. We recruited 41 children who were admitted to emergency service with an SHF and 41 age- and gender-matched children without a fracture history. A semi-structured diagnostic inter- view and a Swanson Nolan Pelham questionnaire were used to obtain data about ADHD symptoms. A clinical intake form was utilized for further clinical data. ADHD symptoms were significantly higher in the fracture group ; male gender, parent- reported proneness to injury, and prior history of trauma were significantly associated with ADHD. Orthopedic surgeons may provide early detection of ADHD by using screening tools or asking questions to caregivers and making referrals when needed. This may lead to prevention of further injuries.

Comparison on effects of platelet-rich plasma versus autologous conditioned serum on Achilles tendon healing in a rat model

OBJECTIVE

The aim of this study was to compare the effects of local administrations of platelet-rich plasma (PRP) with autologous conditioned serum (ACS) on Achilles tendon healing in a rat model.

METHODS

In this study, 40 male Sprague-Dawley rats, aged 12 months and weighing 350 to 400 g were used. The rats were divided into three groups (n=10 in each group): a control group and two treatment groups (PRP vs ACS). A standardized procedure was applied for the complete rupture and repair of the Achilles tendon in each group. The PRP group received one dose of PRP on the operative area, and ACS group received ACS at 24, 48, and 72 hours after the surgery. The control group received no injection. Animals were sacrificed 30 days after the operation, and tendon healing in each group was assessed histopathologically based on Bonar's semi-quantitative score and Movin's semi-quantitative grading scale. For the biomechanical analyses, unoperated Achilles tendons of all rats in the control and ACS groups were also harvested, and pulling tests were applied to the specimen to measure the longitudinal axis strength. The highest force value among the data obtained was defined as the maximum strength value (Fmax).

RESULTS

The mean Bonar's score was significantly lower in the PRP group (3.8±0.8) than in the ACS (4.8±0.45) and control groups (5.2±0.837) (p=0.0028). The mean Movin's score was significantly lower in the PRP group (7.80±1.49) than in the ACS (9.8±1) and control groups (11.2±2.4) (p=0.029). The ratio of type I collagen was significantly higher in the PRP group (60±6) than in the ACS (52±4.5) and control groups (42±9) (p=0.005). Biomechanical results obtained from operated sites were comparable in terms of Fmax among groups (PRP, 33.93±2.61; ACS, 35.24±3.26; control, 35.69±3.62) (p=0.674). Similarly, the results obtained from unoperated sites were comparable among groups (PRP, 47.71±1.21; ACS, 48.14±2; control, 49.14.69±1.88) (p=0.395).

CONCLUSION

In terms of histopathological results, PRP seems to be more effective than ACS for Achilles tendon healing in rats.

Isotretinoin induced achilles tendinopathy: Histopathological and biomechanical evaluation on rats

OBJECTIVE

The aim of the present study was to evaluate histopathological and biomechanical effects of isotretinoin on Achilles tendon.

MATERIALS & METHODS

Sixteen rats were divided into two groups including the control group (n = 8) and isotretinoin group (n = 8). The control group received 1.42 ml/kg soy oil per day whereas the isotretinoin group received 15 mg/kg/day (gavage dose 1.42 ml/kg) isotretinoin dissolved in soy oil through gavage method for 6 weeks. Achilles tendons were excised at the end of week 6. The tendon samples were evaluated by hematoxylin-eosin under a light microscope. Quantitative evaluation was performed via Movin and Bonar scoring. A computer-monitored tensile testing machine was utilised for biomechanical testing. Biomechanical characteristics of the tendon samples (elastic modulus, yield force, ultimate tensile force) were measured.

RESULTS

Histopathological evaluation revealed a significantly higher Movin and Bonar scores in histopathological evaluation. Movin score in isotretinoin group was 4.1 ± 2.5 and it was 2.3 ± 1.0 in control group (p = 0.032). Bonar score in isotretinoin group was 2.9 ± 1.4 and it was 1.6 ± 0.7 in control group (p = 0.022). In line with histopathological evaluation, biomechanical measurements in isotretinoin group (elastic modulus, yield force, ultimate tensile force) were significantly lower than the control group. Elastic modulus in isotretinoin group was 227 ± 27.7 N/mm² and in control group it was 281.7 ± 38.7 N/mm² (p = 0.006). In isotretinoin group; yield force was 33.7 ± 4.3 Pa and in control group it was 40.8 ± 5.9 Pa (p = 0.021). Ultimate tensile force in isotretinoin group was 35.7 ± 4.2 Pa and in control group it was 44 ± 7 Pa (p = 0.009).

CONCLUSION

The present study detected histopathological and biomechanical negative effect of isotretinoin on Achilles tendon. Therefore, isotretinoin should be questioned in medical history of patients with tendinopathy.

The effects of chronic administration of sumatriptan and dipyrone on serotonergic system in the rat brain: an immunohistochemical study

OBJECTIVE

To investigate the effects of chronic high dose sumatriptan and dipyrone treatment on central serotonergic system in rats.

MATERIALS AND METHODS

Male Sprague-Dawley rats (seven per group) were daily injected with sumatriptan (3 mg/kg), dipyrone (400 mg/kg) or saline for 30 days. The brains of animals were surgically removed and immunohistochemically stained for serotonin. Serotonin-positive stained cells were counted automatically by using a computerized image analysis program. Statistical analysis carried out using one-way ANOVA followed by post hoc Tukey test.

RESULTS

A significant decrease in serotonin-positive cells in the brainstem was observed after chronic sumatriptan administration while chronic use of dipyrone induced a significant increase in serotonin-positive cells both in the cortex and midbrain.

CONCLUSION

Our data suggest that central serotonergic system might be modified by chronic use of sumatriptan and dipyrone.

Role of diffusion-weighted MR in differential diagnosis of intracranial cystic lesions

AIM

The purpose of this study was to evaluate the role of diffusion-weighted imaging (DWI) in characterizing cerebral cystic lesions. The usefulness of the apparent diffusion coefficient (ADC) map in lesion characterization was also evaluated.

METHODS

We compared the findings of conventional MR images with those of DWI: 63 cystic masses in 48 patients were examined with routine MR imaging and echo-planar DWI. The routine MR imaging included at least the axial T2- and T1-weighted sequences, and post-contrast T1 axial sequences. The DWI included an echo-planar spin-echo sequence with three values (0, 500 and 1000s/mm(2)) sensitizing gradient in the x, y, z direction, and it obtained an ADC map.

RESULTS

The sensitivity of DWI for differentiating abscesses from primary brain tumours was 100%; for differentiating abscesses from metastatic tumours was 73%; for differentiating benign from malignant lesions was 90%.

CONCLUSION

Although some metastatic lesions may appear hyperintense on DWI thus imitating an abscess, evaluation of the lesions with both DWI and conventional MRI may have an important contribution to the differentiation of tumours from abscesses.

Musicogenic epilepsy with ictal single photon emission computed tomography (SPECT): could these cases contribute to our knowledge of music processing?

Musicogenic epilepsy has a strong correlation with the temporal lobe with a right-sided preponderance. We report the case of a 48-year-old woman whose seizures began at the age of 32 years. Her prenatal, natal and childhood histories were unremarkable and her family history was negative for epilepsy. She had typical complex partial seizures with chewing automatisms. Cranial computed tomography, magnetic resonance imaging (MRI) and interictal SPECT showed no abnormality. Interictal EEG showed paroxysmal bitemporal sharp wave discharges predominant on the right side. Ictal EEG showed a combination of high voltage sharp and slow sharp waves and spikes that originated from the right temporal leads and then became generalized. Ictal activity on EEG started 4-5 min after the music stimulus. For the ictal SPECT study, i.v. injection of 20 mCi of HMPAO was administered approximately 30 s after the ictal activity started. Ictal SPECT demonstrated a right anterior and mesial temporal hyperperfusion. These results seem to support the dominant role of the right temporal lobe and the possible relation of mesial temporal structures to the affective content of music in musicogenic epilepsy.

Diagnostic value of troponin T in neonates of mild pre-eclamptic mothers

The measurement of myocardial damage by newer, highly specific markers of myocardial damage is now possible, including cardiac structural proteins such as troponin T (TnT). In neonates of pre-eclamptic mothers, it identifies minor myocardial damage missed by other biochemical markers. The present study was designed to determine the diagnostic value of TnT concentrations in neonates of pre-eclamptic mothers. Fifteen neonates of pre-eclamptic mothers were studied (9 boys and 6 girls), and 17 healthy full-term neonates (9 boys and 8 girls) were selected as a control group. The serum TnT concentration in neonates of pre-eclamptic mothers (0.70 ng/ml) was significantly higher than that in the control group (0.10 ng/ml). In an echocardiographic study, the mean mitral peak velocity at an atrial contraction (A) value of 39 cm/s in neonates of pre-eclamptic mothers was significantly lower than that in the control group (53 cm/s), and the mean mitral peak velocity of early diastole to peak velocity of the atrial contraction (E/A) value (1.75) in neonates of pre-eclamptic mothers was significantly higher than that in the control subjects (1.23). In conclusion, our study demonstrated high levels of cardiac TnT, lower mitral A values and high mitral E/A values in neonates of pre-eclamptic mothers, presumably associated with mild myocardial damage in the neonates of pre-eclamptic mothers.

Prognostic value of p53, proliferating cell nuclear antigen, and Ki-67 expression in undifferentiated nasopharyngeal carcinomas

In this study the prognostic importance of p53, proliferating cell nuclear antigen (PCNA), and Ki-67 expression was analyzed along with the clinical parameters in 35 consecutive patients with undifferentiated nasopharyngeal carcinomas. Immunohistochemistry was used to detect p53, PCNA, and Ki-67 staining. Among the clinical findings, stage IV disease (P = 0.01), cranial nerve paralysis (P = 0.02), and lymph node metastasis (P = 0.06) were associated with shorter survival. The p53 positivity correlated with the presence of lymph nodes, but it was not a significant factor to predict the outcome. PCNA expression was not found to be a prognostic indicator. On the other hand, the proliferative value of Ki-67 staining was suggestive of prognosis. A proliferation index of Ki-67 less than 10% indicated longer survival (P = 0.03). There was no correlation between Ki-67 staining and PCNA index. As a result, the prognostic value of Ki-67 may alert the physician to more aggressive and adjuvant treatment modalities.

Thyroid function tests in the newborn infants of preeclamptic women

The purpose of this study was to identify possible changes in thyroid functions in newborn infants of preeclamptic women. Fifteen neonates (nine boys and six girls) of preeclamptic women and 17 healthy neonates (nine boys and eight girls) for the control group were included in the study. Serum thyroid-stimulating hormone (TSH), total triiodothyronine (TT3) and total thyroxine (TT4) levels and thyroid gland volumes were determined in both groups. Serum TSH and TT4 levels were not statistically different between the two groups. However, serum TT3 level was 79.22 +/- 40.19 ng/dl in the study group and 40.00 +/- 15.99 ng/dl in control subjects (p < 0.01). The mean right, left and total thyroid volumes were 1.3 +/- 1.2 ml, 1.2 +/- 1.1 ml and 2.4 +/- 2.3 ml in the study group and 0.6 +/- 0.2 ml, 0.6 +/- 0.2 ml, and 1.1 +/- 0.4 ml in the control group, respectively (p < 0.05). The mean thyroid volume/body weight was 0.9 +/- 0.09 ml/kg in the study group and 0.3 +/- 0.06 ml/kg in the control group (p < 0.05). In conclusion, we would like to stress that preeclampsia might be a cause of fetal and neonatal thyroid enlargement and elevated serum TT3 level.

Cherubism: a radiological and clinical presentation

Cherubism is the hereditary form of the fibrous dysplasia of the jaws, but it may be seen sporadically as well. The disease has a self-limited nature and is rarely apparent before the age of two. There is no need to interfere surgically with these lesions of the mandible or the maxilla unless the child is severely affected, i.e. the disease deteriorates respiration, deglutition, vision, or the psychiatric makeup of the child due to cosmetic reasons. The clinical presentation and radiological evaluation of these children are so typical that the pediatrician and pediatric otolaryngologist need to be informed about this rarely seen disease. A case of a cherubic child, with his clinical appearance as well as his radiological evaluation, and discussion about the clinical outcome are presented.

Persistent neonatal hypoglycemia: an unusual finding of congenital hypothyroidism

We report a newborn infant who has congenital hypothyroidism associated with profound and persistent neonatal hypoglycemia. Persistent and marked hypoglycemia has not been previously reported in congenital hypothyroidism to our knowledge. The cause of this condition may be reduced glyconeogenesis or insulin clearance.

A venous anomaly of the neck

Vascular anomalies localize mostly in the head and neck region. Besides the complications they present, when they are left untouched, they are cosmetically ugly. A vascular lesion in any part of the body of a child is always bothersome to the parents and may be a problem for the family. The confusion about classification of these lesions and the delay in seeing the physician may adversely affect the child also. There has been a debate concerning the classification of vascular malformations, their clinical presentation, and their treatment modalities. In this paper we reviewed the classification as accepted in the literature and presented a case of huge venous anomaly in the neck region with its angiographic and MRI views and discussed the possible complications and modes of treatment.

Naloxone and lithium interaction on the levels of homovanillic acid in the rat brain

The effects of long term (10 days) treatment of lithium and naloxone on HVA levels of striatum, hypothalamus and frontal cortex in rats were investigated. Lithium (400 mg/l in drinking water) itself had no effect on HVA levels of any region. Naloxone (2 mg/kg) treatment caused significant increases in the levels of HVA in hypothalamus and striatum and lithium cotreatment prevented the effect of naloxone. Neither of those were observed in the frontal cortical region.

Effect of naloxone on apomorphine-induced changes in locomotor activity of stress-exposed rats

Acute and subacute effects of naloxone (10 mg/kg), apomorphine (0.125 mg/kg; 5 mg/kg) and stressful stimuli (immobilization, cold and sound) on locomotor activity were examined. In both acute and subacute (8 days) treatments, the lower dose of apomorphine decreased locomotor activity and the higher dose of apomorphine increased it. In the acute treatment, naloxone enhanced significantly the depressant effect of the lower dose of apomorphine on locomotor activity. Stress seemed to have no effect on apomorphine induced changes in locomotor activity of rats either in acute or in subacute treatment.

Motility, rigidity and turnover of dopamine in the striatum after administration of morphine to rats: a re-evaluation of their mechanisms

Whether the delayed behavioural activation and the increase in dopamine (DA) turnover in the striatum reflect signs of rebound effects or of counter-regulatory processes directed against locomotor depression and/or muscular rigidity was studied in rats. Administration of a large dose of morphine (30 mg/kg i.p.) induced strong muscular rigidity, which was measured as tonic activity in the electromyogram (EMG). This effect was maximal after one hour and disappeared during the fourth hour. The locomotor activity, on the other hand, disappeared after 30 min and re-appeared during the fourth hour, followed by a locomotor stimulation with a maximum after 4.5 hr. Striatal lesions produced with kainic acid did not affect the complete locomotor depression (akinesia), except by slightly prolonging this effect, and did not influence the delayed locomotor stimulation. These lesions did not inhibit, but, on the contrary, enhanced the increase in striatal concentration of 3,4-dihydroxyphenylacetic acid (DOPAC). Injections of morphine (10 micrograms) into the substantia nigra led to an increase in the level of DOPAC in the ipsilateral, but not the contralateral striatum. These results, in conjunction with those of other authors, suggest that the increase in DA turnover in the striatum and the delayed locomotor stimulation ought to be regarded as actions of morphine on sites different from those mediating muscular rigidity.

Effects of striatal lesions with kainic acid on morphine-induced "catatonia" and increase of striatal dopamine turnover

The influence of striatal lesions (head of the caudate nucleus) with kainic acid on "catatonia" and on the increase of the dopamine metabolite DOPAC in the striatum after systemic morphine administration was measured in rats. These lesions strongly prevented the morphine-induced muscular rigidity, measured as activity in the electromyogram EMG) of the gastrocnemius-soleus muscle of non-anesthesized animals. On the other hand, the decrease of locomotion (akinesia) measured using an Animex Activity Meter and an activity wheel, was not prevented or reduced. The lesions did not influence the inhibitory effect of morphine on the activation of flexor alpha-motoneurones, either. These results suggest that the head of the caudate nucleus plays an important role in mediating morphine rigidity, but not akinesia or inhibition of the activation of flexor alpha-motoneurones. Opioid-induced "catatonia" ought to be regarded as a mixture both of rigidity and of akinesia. Morphine led to a rapid decrease, followed by a slow increase of striatal DOPAC concentration. Lesions induced by kainic acid slightly inhibited the decrease and markedly enhanced the increase of DOPAC. Accordingly, an intact nigro-striato-nigral loop is not necessary for the increase of striatal dopamine turnover, observed after morphine administration. The different sites of action, which are likely to mediate all these effects of morphine, are discussed.

Effect of chronic administration of morphine on primary immune response in mice

The effect of 3 different doses of chronically-administered morphine on the primary immune response was studied in mice by estimating spleen/body weight ratio and serum hemolysin production against sheep red blood cells (SRBC). It was observed that morphine exerted a dose-dependent inhibitory effect on the immune response which was antagonized by the concomitant administration of naloxone. The findings suggest that the inhibitory effect of morphine is specific.