The Relationship of Gastrocnemius-Soleus Muscle Architecture with Balance and Functional Strength in Acute Stroke Patients

Balance and functional impairment could occur due to the weakness of the gastrocsoleus muscles in acute stroke patients. This study was planned to determine the muscle architecture and its relationship to balance and functional strength functional ability in patients with acute stroke. A cross-sectional analysis of 22 stroke patients (68.59 ± 8.16) was performed in this study. Gastrocnemius muscle thickness and cross-sectional area were significantly greater on the non-paretic than on the paretic sides (p = 0.004, p = 0.005, respectively). Partial correlation analysis showed that soleus muscle thickness and cross-sectional area was significantly correlated with Berg Balance Scale, Single Leg Stance Test, Five Times Sit to Stand Test and Tandem test results in the paretic side (r = 0.49-0.77, p < 0.05). The gastrocnemius muscle thickness of the non-paretic side had a significant relationship with balance (r = 0.45-0.65, p < 0.05). The muscle thickness and cross-sectional area of the soleus muscle on the paretic sides was significantly related with the functional strength and balance after stroke. It may be beneficial to develop clinical assessment and intervention programs focusing on distal plantar flexor muscle groups in order to improve the functional status and balance.

Effect of intramuscular fat in the thigh muscles on muscle architecture and physical performance in the middle-aged women with knee osteoarthritis

BACKGROUND

We investigated intramuscular fat (IMF) in quadriceps femoris (QF) and hamstring muscles in the middle-aged women with knee osteoarthritis (KOA). We also examined the relationship between muscular infiltration of QF and hamstring muscles and muscle architecture and physical performance of the women with KOA.

METHODS

In this cross-sectional study, 72 women were included. Body muscle and fat mass were measured by BIA, isometric muscle strength was evaluated by hand-held dynamometer. IMF and muscle architecture were calculated from rectus femoris (RF), vastus intermedius (VIM), vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), semitendinosus (ST) and semimembranosus (SM) using B-mode ultrasonography. KOA-related symptoms and functions were assessed with KOOS. The functional performance assessments were evaluated with Stair Climbing Test, 20-Meter Walking Test.

RESULTS

Women with KOA had more IMF in RF, VIM, VL, VM and BF, ST, SM muscles compared to the healthy women. Pennation angles decreased as the IMF in the RF, VM, BF and ST decreased. As the IMF of the RF and VM increased isometric knee extensor strength decreased and KOOS symptom score, pain score and ADL score increased in women with KOA. Walking and stair climbing speed deteriorated as the IMF in RF, VIM, VM, BF increased in the middle-aged women. As the IMF in BF increased isometric knee flexor strength decreased and KOOS scores increased. Physical performance scores deteriorated as the IMF in BF increased in middle-aged women with KOA.

CONCLUSION

IMF in QF and hamstring muscles were higher in the middle-aged women with KOA group compared with that in the healthy group. Weakness of the QF and hamstring muscles may due to the changes in architectural properties of muscle depending on muscular infiltration. IMF in knee muscles is an important determining factor in performance and physical function of middle-aged women with KOA.

Bilateral Barotraumatic Involvement of the Infraorbital Nerve with Dehiscence and Ectopic Course: A Case Report

The infraorbital nerve is responsible for the sensory innervation of the lower eyelid, the lateral nose, the cheek, the upper lip, and the maxillary teeth. It passes along the infraorbital canal, which runs superior to the maxillary sinus. Dehiscence of the infraorbital canal and its ectopic course in the maxillary sinus is a rare variation. A nerve with these variations may be affected by pathologies in the maxillary sinus and this may constitute a rare cause of facial pain. In this report, we present the clinical symptoms of a 29-year-old male patient who had an infraorbital nerve with an ectopic course and dehiscence in light of the literature.

Coexistence of Adenoid Cystic Carcinoma and Sialolithiasis in Submandibular Gland: Case Report

Sialolithiasis is the primary cause of swelling in the major salivary glands. The etiopathogenesis is not clear. Adenoid cystic carcinoma is a slow-growing salivary gland malignancy with a poor prognosis. There are only a few cases in the literature reporting the coexistence of sialolithiasis and adenoid cystic carcinoma. In this report, we present a case that was thought to have sialolithiasis in the foreground because of the calcified image on computed tomography, but was diagnosed with adenoid cystic carcinoma after excision, together with a discussion of the relationship between sialolithiasis and carcinogenesis.

Atypical Lipomatous Tumor Originating From the Nasopharynx in a Patient with Chronic Lymphocytic Leukemia

Atypical lipomatous tumor, also known as well-differentiated liposarcoma, is rare in the head and neck region. The primary and most effective option in the treatment of this malignancy with a good prognosis is excision with clean surgical margins. Therefore, it is important to distinguish this malignancy from lesions that require more aggressive treatment. In this article, we present the case of an atypical lipomatous tumor originating from the nasopharynx and almost completely obstructing the oropharynx in a 38-year-old male patient with chronic lymphocytic leukemia. To the best of our knowledge, this is the first report in the literature of an atypical lipomatous tumor case originating from the nasopharynx.

Artificial Intelligence in Healthcare Competition (TEKNOFEST-2021): Stroke Data Set

OBJECTIVE

The artificial intelligence competition in healthcare was organized for the first time at the annual aviation, space, and technology festival (TEKNOFEST), Istanbul/Türkiye, in September 2021. In this article, the data set preparation and competition processes were explained in detail; the anonymized and annotated data set is also provided via official website for further research.

MATERIALS AND METHODS

Data set recorded over the period covering 2019 and 2020 were centrally screened from the e-Pulse and Teleradiology System of the Republic of Türkiye, Ministry of Health using various codes and filtering criteria. The data set was anonymized. The data set was prepared, pooled, curated, and annotated by 7 radiologists. The training data set was shared with the teams via a dedicated file transfer protocol server, which could be accessed using private usernames and passwords given to the teams under a nondisclosure agreement signed by the representative of each team.

RESULTS

The competition consisted of 2 stages. In the first stage, teams were given 192 digital imaging and communications in medicine images that belong to 1 of 3 possible categories namely, hemorrhage, ischemic, or non-stroke. Teams were asked to classify each image as either stroke present or absent. In the second stage of the competition, qualifying 36 teams were given 97 digital imaging and communications in medicine images that contained hemorrhage, ischemia, or both lesions. Among the employed methods, Unet and DeepLabv3 were the most frequently observed ones.

CONCLUSION

Artificial intelligence competitions in healthcare offer good opportunities to collect data reflecting various cases and problems. Especially, annotated data set by domain experts is more valuable.

Transoral penetrating upper cervical injury: a case report

Transoral penetrating foreign body injury of the neck involving the cervical spine is a rare condition. We present an injury caused by transoral penetration of a broken piece of a wooden plank into the neck with injury to the upper cervical spine in a 31-year-old male patient. The foreign body was removed transorally with the patient making a full recovery under close observation and was discharged and followed up with no complications. This paper highlights the types of neck injuries, the key points to be considered in zone III neck injury in light of existing literature and a discussion on the management of these patients.

Uma Apresentação Rara de COVID-19 com Embolia Pulmonar

A doença de coronavírus 2019 (COVID-19) foi relatada em quase todos os países do mundo desde dezembro de 2019. A infecção por SARS-CoV-2 é frequentemente assintomática ou com sintomas leves, mas também pode levar à hipóxia, um estado hiperinflamatório e coagulopatia. Os parâmetros de coagulação anormais estão associados a complicações trombóticas, incluindo embolia pulmonar na COVID-19, mas pouco se sabe sobre os mecanismos. A semelhança dos sintomas iniciais de ambas as doenças também pode ser confusa, portanto, os médicos devem estar cientes do potencial para condições concomitantes. Apresentamos aqui um caso que não apresentava opacidades em vidro fosco nos pulmões, mas apresentava embolia pulmonar e derrame pleural em associação com infecção por COVID-19.

Ultrasound imaging of quadriceps muscle in patients with knee osteoarthritis: The test-retest and inter-rater reliability and concurrent validity of echo intensity measurement

BACKGROUND

Echo intensity(EI) on ultrasonography images of skeletal muscle reflects muscle composition.

OBJECTIVES

The primary aim of the study was to investigate the inter-rater and test-retest reliability of EI using grayscale histogram analysis of the cross-sectional area of quadriceps femoris(QF) muscle in patients with knee osteoarthritis(KOA). The secondary aim of the study was to determine the concurrent validity of the Free Hand Tool(FHT) when compared to Rectangular Marquee Tool(RMT) for calculating the region of interest(ROI) in ImageJ.

METHODS

This study included thirty patients with KOA. Echogenicity of the QF muscle were performed by two different raters. The reliability analysis was applied using intraclass correlation coefficient(ICC), standard error of measurement(SEM) and coefficient of variation(CV). Spearman rank correlation coefficients were calculated for assessing concurrent validity of the FHT to RMT. The Bland-Altman plots was used to show disagreement between tools. Wilcoxon signed-rank test was used for differences in assessments between test/retest sessions, raters, tools.

RESULTS

The inter-rater and test-retest reliability of the EI using FHT and RMT was found to be excellent (ICC_FHT = 0.91-0.95, 0.98-0.99, ICC_RMT = 0.91-0.98, 0.91-0.99,respectively). Bland-Altman analysis demonstrated a slight bias when region ROI calculations were collected from RMT or FHT (bias ranging from 2.75 to-2.40 a. u). There were no significant differences between test/retest sessions, raters and tools(p > 0.05). Spearman correlation coefficient showed excellent correlation between tools used for echogenicity assessment of QF muscle(p < 0.001).

CONCLUSION

EI assessment using ultrasonography in the QF muscle showed excellent reliability. Evaluating muscle echogenicity using both FHT and RMT appears to be reliable and validity for monitoring muscle changes due to KOA.

Common coeliacomesenteric trunk: a computed tomography radiological study

BACKGROUND

There is an increasing trend for administration of invasive radiological interventions, laparoscopic surgery, and transplantation procedures in recent years, and determining the vascular variations prior to these procedures is crucially important. Coeliacomesenteric trunk (CMT) is among these variations. This study aimed to retrospectively evaluate this rare anomaly by computed tomography (CT).

MATERIALS AND METHODS

A total of 1000 CT angiography images were analysed retrospectively, and the patients with mesenteric and coeliac arteries arising from the abdominal aorta with a single root were identified. The level that CMT arose, and its branching patterns were determined individually for all patients.

RESULTS

Ten patients (6 males and 4 females) with a mean age of 50.2 years (17-87 years) had CMT in CT images.

CONCLUSIONS

The knowledge of variations in the CMT prior to vascular or laparoscopic interventions will contribute to early intervention in case of a complication, or to avoid from a potential damage.

Pyelolymphatic backflow demonstrated by an abdominal CT: A case report

BACKGROUND

Pyelolymphatic backflow phenomenon, which is a subtype of pyelorenal backflow, is a rare condition that occurs during the acute phase of urinary obstruction. Pyelorenal backflow has already been described in humans with retrograde pyelography. Our report presents a rare case of pyelolyphatic backflow demonstrated by a computed tomography.

CASE REPORT

A 67-year-old man with a history of bladder carcinoma was admitted to the emergency department due to right-sided flank pain and hematuria. Hematuria resolved after insertion of a 3-way urinary catheter, but flank pain persisted. As a result, an abdominopelvic CT was performed. CT revealed numerous tiny, serpiginous tubular structures connected with each other and filled with urine. They began intrarenally and extended caudally surrounding the ureter in the retroperitoneum. Subsequently, the patient underwent an ultrasound-guided nephrostomy to decompress the collecting system of the right kidney. Antegrade pyelography revealed minimal hydroneprosis. However, no leakage from the ureter to the retroperitoneum was observed, proving that the changes demonstrated by a CT were due to pyelolymphatic reflux caused by increased pressure in the collecting tubules filling the lymphatics with opaque urine.

CONCLUSIONS

This report presents a very rare case of pyelolymphatic reflux demonstrated by a CT. We present this case report as a reminder that although rare, pyelolymphatic reflux can occur as a result of obstruction without manifestations of hydronephrosis and it can be confused with leakage from the ureter.