Comparison of five different fluoroscopic methods for identifying the MPFL femoral footprint.

PURPOSE: The success of medial patellofemoral ligament (MPFL) reconstruction is closely linked to the precise positioning of the femoral tunnel. Intraoperative fluoroscopy is commonly utilized to identify the MPFL footprint. This study aimed to ascertain the most accurate fluoroscopic method among the five previously described methods used to determine the MPFL femoral footprint. MATERIALS AND METHODS: Using 44 well-preserved dry femur bones, the MPFL femoral insertion site was demarcated using anatomical bony landmarks, namely the center of the saddle sulcus between the medial epicondyle, adductor tubercle and gastrocnemius tubercle. Fluoroscopic true lateral knee images were acquired and measurements taken, referencing established methods by Schottle et al., Redfern et al., Wijdicks et al., Barnett et al., and Kaipel et al. The distance between anatomic and fluoroscopic MPFL footprints was then measured on digital fluoroscopic images. The accuracy of the locations was compared using a margin of error of 5 and 7 mm. RESULTS: The Schottle method consistently emerged superior, showcasing the smallest mean distance (3.2 ± 1.2 mm) between the anatomic and radiographic MPFL footprints and a high in-point detection rate of 90.9% under 5 mm criteria. While the Redfern method displayed perfect accuracy (100%) within the 7 mm criteria, the Schottle method also performed 97.7% accuracy. CONCLUSIONS: For intraoperative identification of the MPFL footprint using fluoroscopy, the Schottle method is the most consistent and accurate among the assessed methods. Thus, its accuracy in detecting the MPFL footprint makes it recommended for MPFLR to ensure optimal outcomes. LEVEL OF EVIDENCE: Level IV, cadaveric study.

Prediction Of Palmaris Longus Tendon Length And Thickness Through Simple Anthropometric Measurements.

OBJECTIVE: This study aimed to test whether palmaris longus tendon (PLT) length and thickness can be predicted from simple anthropometric measurements. MATERIALS AND METHODS: 120 healthy volunteers with bilateral PL muscles were enrolled in this prospective study. PLT length and thickness were measured by ultrasonographic examination. Anthropometric measurements included body height, weight, forearm length, and wrist circumference. Correlation, linear regression, and Bland-Altman plot were used for analysis. RESULTS: The mean PLT length and thickness were 10.8±1.4 cm and 4.0±0.9 mm, respectively. Body height and PLT length had a moderate positive correlation (r:0.407, p:0.001), and forearm length and PLT thickness had a weak positive correlation (r:0.229, p:0.001). The regression analysis showed that body height was the best predictor for PLT length, and forearm length was the best predictor for PLT thickness. The regression equations were as follows: PLT length=0.276+(0.062×height) (r2=0.165, p<0.001) and PLT thickness=1.373+(0.108×forearm length) (r2=0.052, p<0.001). The predicted PLT lengths and thicknesses were calculated using these regression formulas and compared with the actual thicknesses and lengths using the Bland-Altman plot. The upper and lower limits of agreement (95% CI) ranged from -2.54 cm to 2.51 cm for actual PLT length and predicted PLT length and from -1.76 mm to 1.74 mm for actual PLT thickness and predicted PLT thickness in the Bland-Altman plot with a weak agreement and proportional bias. CONCLUSIONS: These findings indicate that height and forearm length have limited accuracy in predicting PLT length and thickness. The preoperative ultrasonographic examination can provide valuable assistance, particularly in cases that require grafts with precise length and thickness requirements.

Oxaliplatin­induced changes in splenic volume and liver fibrosis indices: retrospective analyses of colon cancer patients receiving adjuvant chemotherapy.

The aim of our study was to evaluate the association between increased splenic volume (SV) and liver fibrosis indices in colon cancer patients receiving oxaliplatin-based adjuvant chemotherapy. Patients who received adjuvant oxaliplatin-based regimens with the diagnosis of stage II and III colon cancer were evaluated. Splenic volume measurements, liver function tests, platelet count, and non-invasive liver fibrosis indices [NAFLD fibrosis score (NFS), AST to platelet ratio (APRI), and Fibrosis-4 (FIB-4)] were measured before and after treatment. A 30% increase in SV after chemotherapy compared to baseline was considered increased SV. The rate of increase in SV was 57.7% in the whole group. An increase in SV was shown at a higher rate in patients treated with capecitabine and oxaliplatin (CAPOX) than those treated with 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) (66.3% vs. 36.8%, p = 0.002). Furthermore, the CAPOX regimen (OR: 2.831, 95% CI: 1.125-7.121; p = 0.027), and higher post-treatment FIB-4 score (OR: 3.779; 95% CI:1.537- 9.294, p = 0.004) were determined as independent risk factors for the increased SV. Our study revealed that increased SV had a significant association with higher FIB-4 score in patients treated with oxaliplatin-based chemotherapy.

Diagnostic Concordance and Discrepancies in 3D TVUS and MRI of Congenital Uterine Malformations across the ASRM 2016, ASRM 2021, ESHRE/ESGE 2016, and CUME 2018.

BACKGROUND: The classification of Congenital Uterine Malformations (CONUTA) relies on coronal imaging of the uterus using 3D TVUS and MRI. In everyday practice, radiologists and gynaecologists often struggle to confidently categorize CONUTA due to varying classification systems and the lack of worldwide consensus. OBJECTIVES: The aim of this study was to evaluate the diagnostic concordance and discrepancies between two imaging techniques within the context of the ASRM, ESHRE/ESGE, and CUME systems. METHODS: Ninety-four patients suspected of having CONUTA underwent evaluation: 67 underwent 3D TVUS, 53 had MRI scans, and 34 were examined using both imaging techniques. An initial cross-listing table of ASRM, ESHRE/ESGE, and CUME was created, and a flowchart schema was used to define the type of congenital uterine anomaly for each system The prevalence of anomalies in each system was calculated, and Fleiss' Kappa was used to assess and determine the level of agreement. RESULTS: Class VI arcuate uterus was the most common form in ASRM 2016 and 2021, while the partially septate uterus predominated in the CUME 2018 and ESHRE/ESGE 2016 classification systems. CONCLUSION: There is no discordance between classification systems for all fusion defects and complete septate type of absorption defects. In the ESHRE/ESGE system, nearly half of the abnormal uteruses were categorized as partially septate. However, the CUME system proved less effective in distinguishing between normal and arcuate uteruses.

Perceived use and value of reproductive, problem-solving, and athlete-initiated teaching by coaches and athletes.

In the sports coaching environment, it is recognized that developing athletes' autonomy and problem-solving skills are crucial to support holistic development and ensure optimal performance. However, there needs to be more information on how coaches use and value different teaching methods in training and how athletes perceive and value these methods. This study aimed to examine coaches' and athletes' perceptions of the use and value of reproductive, productive problem-solving, and productive athlete-initiated teaching methods. To this end, the Coaches' Use of Teaching Methods Scale which is validated for the use of coaches and athletes, was applied to 70 coaches and their 294 athletes of youth sports teams purposefully selected from four cities in Türkiye. Data were analyzed by nonparametric methods, including Friedman's and Mann-Whitney tests (p < 0.05). Although there were statistically significant differences between the responses of coaches and athletes regarding the use of different teaching methods in their training and the value they gave to these methods, both groups marked the frequent use of reproductive, occasional use of productive problem-solving and rare use of productive athlete-initiated teaching methods during training. The value given to productive athlete-initiated teaching methods in terms of enjoyment, learning, and motivation by the athletes was higher than the value given to them by the coaches. The study's findings strongly indicate the coaches' professional needs in their pedagogical knowledge, specifically on their value perceptions of productive problem-solving and productive athlete-initiated teaching methods and the capacity to apply them.

When a balloon catheter or tenaculum is required for cervical traction during hysterosalpingography.

The aim of this study was to define the actual rate of the traction needed and the balloon catheter or tenaculum requirement for hysterosalpingography (HSG) examinations, and to investigate the correlation between pain scores with the type of traction, operator, parity or the type of infertility. 788 patients undergoing HSG participated in the trial. The HSG examinations were completed in 58% of the patients (458) without any traction. Traction was needed in 42% of patients, those with the balloon catheter in 26.9%, and those with the tenaculum only at 15%. Patients with balloon catheter traction had similar pain scores to those using tenaculum traction. The pain scores changed according to the operator. HSG examinations should be performed step-by-step and the need for traction evaluated during the procedure.IMPACT STATEMENTWhat is already known on this subject? HSG is a technique to evaluate fallopian tube patency and other potential intrauterine pathology in infertile women.What do the results of this study add? Traction was not needed in more than half of the HSG examinations. The pain due to the balloon catheter and tenaculum is similar.What the implications are of these findings for clinical practice and/or further research? HSG examinations should be performed step-by-step by checking the need for traction. Traction with the balloon catheter prevents the uterine spasm, infection and bleeding complications during or after the HSG.

Effects of Sarcopenia, Myosteatosis, and the Prognostic Nutritional Index on Survival in Stage 2 and 3 Gastric Cancer Patients.

BACKGROUND: We aimed to evaluate the relationship between sarcopenia, myosteatosis, and systemic inflammatory response biomarkers and their prognostic role in stage 2 and 3 gastric cancer patients. METHODS: This study included 84 patients with stage 2 or 3 gastric cancer who underwent a gastrectomy. Computed tomography scans were used to determine the skeletal muscle index (SMI) at the third lumbar vertebra level for sarcopenia and myosteatosis. RESULTS: Based on the Asian Working Group of Sarcopenia (AWGS2019) criteria, the sarcopenia incidence was 36.9% and that of myosteatosis 46.4%. Univariate analysis showed that sarcopenia (48 vs. 14 mo, p < 0.001), myosteatosis (45 vs. 16 mo, p = 0.016), a low prognostic nutritional index (60 vs. 15 mo, p = 0.003), stage 3 (104 vs. 21 mo, p = 0.013), and old age (45 vs. 16 mo, p = 0.015) were poor prognostic markers. Multivariate analysis revealed that sarcopenia (AWGS2019), age, and stage significantly affected overall survival (hazard ratio: 3.31, 95% CI: 1.85-5.1; 1.96, 95% CI: 1.06-6.63; 2.5, 95% CI: 1.2-5.1, respectively). CONCLUSION: We showed that sarcopenia directly affects overall gastric cancer survival.

Treatment of carpal tunnel syndrome by low-level laser therapy versus corticosteroid injection: a randomized, prospective clinical study.

To compare the effects of low level laser therapy (LLLT) and corticosteroid injection in patients with moderate carpal tunnel syndrome (CTS). Eighty-seven patients (143 wrists) with moderate CTS were randomized to the corticosteroid or LLLT groups. 40 mg of triamcinolone acetate solution was applied to carpal tunnel of 44 patients (74 wrist). LLLT was applied to 43 patients (70 wrist) five times a week, for a total of 15 sessions (fluence of 6 j/cm2 for 1 min per point at a wavelength of 830 nm). Outcome measures were numbness and pain, QuickDASH questionnaire, grasping tests, Tinel and Phalen tests, electrophysiological tests and MRI evaluations, which were tested at the baseline and 1st and 6th months after the treatment. Eighty patients (133 wrists) completed the study at the end of 6 months. VAS and Quick DASH scores were better in the corticosteroid group in the 1st month, but there were no significant differences between groups in the 6th month. Phalen and Tinel tests, strength tests, and motor distal latency improved significantly and similarly in both groups at the 1st and 6th months. Sensory distal latency and sensory nerve conduction velocity showed significant improvements in the 1st and 6th months only in the corticosteroid group. In both groups, median nerve intensity rate and palmary spring rate improved significantly after the treatment. Based on this study, corticosteroid injection and LLLT groups showed statistically significant difference at the 1st month (short-term), whereas there was no significant difference at the 6th month (intermediate-term).

The effect of bronchiectasis on the exacerbation and mortality of chronic obstructive pulmonary disease.

BACKGROUND: Coexistence of bronchiectasis with chronic obstructive pulmonary disease (COPD) may lead to the worsening of the functional parameters in exacerbations and may negatively affect the outcomes. METHODS: This study is a retrospective cross-sectional study that aims to investigate the relationships between bronchiectasis with COPD exacerbation and all-cause of mortality. We retrospectively enrolled 122 cases hospitalized for COPD exacerbation from 2010 to 2016. Patients who underwent thoracic tomography in the previous year of the index exacerbation were included in the study. Patients who admitted to the intensive care unit and patients with infected bronchiectasis and with conditions that mimic COPD exacerbation were excluded from the study. Demographic, clinical, and laboratory findings, comorbidities and the number of exacerbations in the previous year and the presence of bronchiectasis were recorded using hospital electronic registry. The radiological evaluation of bronchiectasis was made by the modified Reiff score (MRS). RESULTS: Bronchiectasis was found in 66 (54%) of 122 patients included in the study. The mean age was 67.5 ± 10.3 in the whole group, 108 (88.5%) of the patients were male, and 14 (11.5%) were female. When patients were stratified according to the presence of bronchiectasis, no statistically significant difference was found in terms of comorbidity scores, respiratory functions, exacerbation parameters, laboratory values and all cause of mortality between the groups (p > 0.05). There was no statistical relation between the presence of bronchiectasis and long-term survival (log-rank test p = 0.83). CONCLUSIONS: This study shows that patients with bronchiectasis did not cause a poor outcome in patients with COPD exacerbation.

Prevalence and associated risk factors of coronary artery disease in patients with a zero coronary calcium score.

PURPOSE: A zero coronary calcium score (CCS) is not able to provide a definite exclusion for coronary artery disease (CAD). The goal of this study was to determine the prevalence and associated cardiovascular risk factors of CAD in patients with zero CCS. METHODS: Six hundred thirteen patients with zero CCS referred to coronary calcium score analysis (CCSA) and coronary computed tomography angiography (CCTA) with suspicion of CAD were included. The descriptive, univariate, and multivariate analyses were used to determine the prevalence and predictors of CAD presence. RESULTS: Among 613 patients, 17 patients (2.7%) have NCCP, and obstructive CAD was found in 3 patients (0.48%). Multivariate analysis revealed that male gender and older age (≥50 years) were significantly associated with the presence of noncalcified coronary plaques (NCCP) (p < 0.05). The receiver operating characteristic (ROC) curve analysis showed that the male gender and older age (≥50 years) model had 70.6% sensitivity and 84.2% specificity for predicting NCCP. CONCLUSION: A non-negligible portion of patients with zero CCS had CAD. Male gender and older age (≥50 years) were independently associated with NCCP. Due to the high specificity value (84.2%) and negative predictive value (99.0%) of the male gender and older age (≥50 years) model, selective use of CCTA is recommended in <50 years old female patients to avoid unnecessary radiation exposure.

Added Value of CT Pelvic Bone Unfolding Software to Radiologist Performance in Detecting Osteoblastic Pelvic Bone Lesions in Patients With Prostate Cancer.

PURPOSE: To evaluate the contribution of CT Bone Unfolding software to the diagnostic accuracy and efficiency for the detection of osteoblastic pelvic bone lesions in patients with prostate cancer. METHODS: A total of 102 consecutive (January 2016-September 2019) patients who underwent abdominopelvic CT with prostate cancer were retrospectively evaluated for osteoblastic pelvic bone lesions, using commercially available the post-processing-pelvic bone flattening-image software package "CT Bone Unfolding." Two radiologists with 3 and 15 years of experience in abdominal radiology evaluated CT image data sets independently in 2 separate reading sessions. At the first session, only MPR images and at the second session MPR images and additionally unfolded reconstructions were assessed. Reading time for each patient was noted. A radiologist with 25 years of experience, established the standard of reference. RESULTS: In the evaluations performed with the MPR-Unfold method, the diagnostic accuracy were found to be 2.067 times higher compared to the MPRs method (P < 0.001). The location of the lesions or the reader variabilities did not show any influence on accuracy (P > 0.05) For all readers the reading time for MPR was significantly longer than for MPR-Unfold (P < 0.05). For both methods substantial to almost-perfect inter-reader agreement was found (0.686-0.936). CONCLUSIONS: The use of unfolded pelvic bone reconstructions increases diagnostic accuracy while decreasing the reading times in the evaluation of pelvic bone lesions. Therefore, our findings suggest that utilizing unfolded reconstructions in addition to MPR images may be preferable in patients with prostate cancer for the screening of osteoblastic pelvic bone lesions.

Evaluation of a two-image technique consisting of an axial and a coronal image generated by using the rib-flattening application: effect on reading time and diagnostic validity

Background/aim: When reading a chest CT, a radiologist needs to evaluate each rib one by one due to complex curvy shape, which makes reporting a tiresome and time-consuming task. A new curved planar reformat application that flattens ribs on a single plane may find a place in the radiology reporting room. This study aimed to evaluate the effect of a two-image set created by using the rib-flattening application on the performance of a radiologist in detecting sclerotic rib lesions in cancer patients. Materials and methods: The local Institutional Review Board approved this retrospective study. Two radiologists with different experience levels reviewed chest CT examinations of 106 patients (76 men, 30 women). We divided the patients into group A (n = 54), reviewed by a standard method, and group B (n = 52), reviewed by a standard method and the two-image set created on the rib- flattening application. Reading times, validity indices, and agreement levels with reference data were evaluated for both readers. Results: The median reading time of the junior examiner significantly decreased with the rib-flattening method (160.5 s vs. 70.0 s; P < 0.001). Diagnostic indices of the senior reader were improved significantly at per patient level (group A, AUC: 0.867; group B, AUC: 0.982; P = 0.046). The new method showed better agreement levels (kappa: 0.69 to 0.96) than the general method (kappa: 0.53 to 0.91). Conclusion: Based on improved agreement levels, reading times, and diagnostic validity indices we conclude that a two-image set consisting of an axial and a coronal flattened-rib image may be used in conjunction with an ordinary exam.

Correlation Between Semen Analysis Parameters and Diffusion-Weighted Magnetic Resonance Imaging of the Testicles in Patients With Varicocele: A Pilot Study.

PURPOSE: The aims of this study were to evaluate using testicle apparent diffusion coefficient (ADC) values in patients with varicocele and compare them with those of healthy individuals, to identify an optimal ADC threshold level to predict abnormal semen analysis using diffusion-weighted imaging. MATERIALS AND METHODS: Thirty-one patients with the diagnosis of varicocele and 20 healthy controls were enrolled in the study. All subjects underwent testicle diffusion-weighted imaging at b values of 0, 400, and 800 s/mm and semen analysis. Student t tests were used to compare continuous variables between 2 groups. Testicle ADC values were correlated with semen analysis parameters. The relationship between ADC values and impaired semen analysis parameters was evaluated using Pearson correlation coefficient analysis. Receiver operating characteristic curves were formed. Cut-off values for ADC, sensitivity, and specificity values were measured. RESULTS: There was a negative correlation between mean ADC values and plexus pampiniformis vein diameter (r = -0.467, P < 0.001) and a positive correlation between mean ADC values and sperm count (r = 0.838, P < 0.001) as well as sperm morphology (r = 0.548, P < 0.05). Sensitivity values of 94.3% and 86.6% and specificity values of 87.5% and 43.8% were determined for the best cut-off ADC values in diagnosing the sperm count and morphology, respectively (area under the curve, 0.961 and 0.781). CONCLUSIONS: Decreased testicular ADC values in patients with varicocele are significantly correlated with semen parameters. This method may be used to determine the degree of testicular parenchymal destruction. In addition, testicular ADC cut-off values might be useful in dyspermia patients for the management of patients with varicocele.

Comparison of Resorbable Mesh (Poly L-Lactide/Glycolic Acid) and Porous Polyethylene in Orbital Floor Fractures in an Experimental Model.

BACKGROUND: Resorbable mesh and porous polyethylene are frequently used alloplastic materials for the treatment of the orbital blowout fractures. The literature lacks reports comparing their long-term effects on experimental models. OBJECTIVE: Our aim was to radiologically and histologically evaluate the effectiveness and safety of porous polyethylene and resorbable mesh in a rabbit orbital blowout fracture model. METHODS: Twelve New Zealand white rabbits (24 orbits) were randomized to 4 groups. In group 1, only orbital floor dissection was done. In group 2, following orbital floor dissection, a 10-mm defect was created without any extra procedure. In group 3, following a 10-mm defect creation, a 12-mm-round cut porous polyethylene was placed on the defect. In group 4, following a 10-mm defect creation, a 12-mm-round cut resorbable mesh was placed on the defect. Computed tomographic analysis was performed during follow-up period. Orbital floors were evaluated histologically at month 6. RESULTS: No clinical complications were observed during follow-up period. In radiological evaluation, there was no statistically significant difference between groups regarding bone formation. In histological evaluation, the connective tissue was denser, and organized and better bone formation was observed in group 3 and 4 when compared with other groups. CONCLUSION: Although no significant radiological changes were present, porous polyethylene and resorbable mesh performed better histologically. They were effective and well tolerated for reconstruction of the isolated orbital floor defects.

HISTORIQUE: Le treillis résorbable et le polyéthylène poreux sont des matériaux alloplastiques souvent utilisés pour traiter les fractures isolées du plancher de l'orbite. Les publications ne contiennent pas de rapports sur les effets à long terme de ces matériaux dans des modèles expérimentaux. OBJECTIF: Les chercheurs visaient à évaluer l'efficacité et la sécurité du polyéthylène poreux et du treillis résorbable sur le plan radiologique et histologique dans un modèle de fracture isolée du plancher de l'orbite chez un lapin. MÉTHODOLOGIE: Douze lapins blancs néo-zélandais (24 orbites) ont été répartis au hasard en quatre groupes. Le groupe 1 a seulement subi la dissection du plancher de l'orbite. Dans le groupe 2, après cette dissection, une anomalie de 10 mm a été créée sans intervention supplémentaire. Dans le groupe 3, après la création d'une anomalie de 10 mm, une coupe ronde de polyéthylène poreux de 12 mm a été placée sur l'anomalie. Dans le groupe 4, après la création d'une anomalie de 10 mm, une coupe ronde de treillis résorbable de 12 mm a été placée sur l'anomalie. Les chercheurs ont effectué une analyse tomodensitométrique pendant la période de suivi. Au sixième mois, ils ont évalué les planchers orbitaux à l'histologie. RÉSULTATS: Les chercheurs n'ont observé aucune complication clinique pendant la période de suivi. À l'évaluation radiologique, la formation osseuse ne présentait aucune différence statistiquement significative entre les groupes. À l'évaluation histologique, les tissus conjonctifs étaient plus denses et la formation osseuse était organisée et de meilleure qualité dans les groupes 3 et 4 que dans les autres groupes. CONCLUSION: Malgré l'absence de modification significative à la radiologie, le polyéthylène poreux et le treillis résorbable donnaient de meilleurs résultats sur le plan histologique. Ces matériaux étaient efficaces et bien tolérés pour la reconstruction des anomalies isolées du plancher orbital.

Unfused or twig-like middle cerebral artery.

INTRODUCTION: The knowledge of anatomic variations of the cerebral arterial circulation may be important to decide on the safest surgical or endovascular treatment method. Variations in the middle cerebral artery (MCA) territory seems to be less frequent than the other intracranial arteries. During the embryonic stage the primitive MCA is hypothesized to be made up of arterial twigs and these twigs will generate the definitive MCA at the end of the development stage. As in our cases, an early interruption in this period will prevent the evolution of MCA normally and a plexiform arterial network will create the M1 segment of MCA which is the so-called extremely rare unfused or twig-like (Uf/Tw) MCA variation. Our aim is to define and evaluate the angiographical features of Uf/Tw MCA. METHODS: The diagnosis of Uf/Tw MCA was evaluated in a total of 4855 diagnostic cerebral catheter angiograms, retrospectively. The coexisting intracranial pathologies were also interpreted with former radiological examinations. A review of the literature is provided. RESULTS: A total of six cases of Uf/Tw MCA was identified on angiograms accompanying ipsilateral internal carotid artery (ICA) occlusion and contralateral ICA supraclinoid segment aneurysm in one case, and cingulate gyrus AVM in the other. In two different cases, CT or MRI examinations revealed coexisting subarachnoid hemorrhage and misdiagnosis of forniceal AVM in one case, and temporal arachnoid cyst and parenchymal hematoma in the other. CONCLUSION: Lack of data and knowledge about the Uf/Tw MCA variation may cause misdiagnosis and unnecessary treatment attempts.

A proven case of cutaneous rhizopus infection presenting with severe limb pain very soon after induction treatment in a patient with acute lymphoblastic leukemia.

Objective and Importance. Invasive mucormycosis may complicate the course of patients with hematologic malignancies and has a very high mortality rate. Early diagnosis and aggressive approach combined with surgical and medical treatment have paramount importance for cure. Clinical Presentation. We report here a case of a patient with acute lymphoblastic leukemia presenting with a subcutaneous mass lesion which was sampled by an ultrasound guided needle biopsy. The pathology showed microorganisms with aseptate hyphae with wide, irregular walls and more or less branching with highly vertical angles which suggested a mold infection. The specimen was also cultured where Rhizopus spp. grew. Conclusion. Posaconazole 200 mg QID was commenced. She recovered from neutropenia and pain on day 20 of treatment. After 4 courses of hyper-CVAD chemotherapy, the remaining soft tissue mass was removed surgically and she underwent allogeneic HSCT from a full matched sibling donor under secondary prophylaxis.

Use of Sports Science Knowledge by Turkish Coaches.

The purpose of this study is to examine the following research questions in Turkish coaching context: a) What are coaches' perceptions on the application of sport science research to their coaching methods? b) What sources do coaches utilize to obtain the knowledge they need? c) What barriers do coaches encounter when trying to access and apply the knowledge they need for their sport? In addition, differences in research questions responses were examined based on gender, years of coaching experience, academic educational level, coaching certificate level, coaching team or individual sports, and being paid or unpaid for coaching. The participants were 321 coaches (255 men, 66 women) from diverse sports and coaching levels working in Ankara. The questionnaire "New Ideas for Coaches" by Reade, Rodgers and Hall (2008) was translated, adapted into Turkish, and validated for the current study. According to our findings among Turkish coaches, there is a high prevalence of beliefs that sport science contributes to sport (79.8%);however, there are gaps between what coaches are looking for and the research that is being conducted. Coaches are most likely to attend seminars or consult other coaches to get new information. Scientific publications were ranked very low by the coaches in getting current information. The barriers to coaches' access to sport science research are finding out the sources of information, being able to implement the sport science knowledge into the field of coaching, lack of monetary support in acquiring knowledge, and language barriers. Also, differences in perceptions and preferences for obtaining new information were identified based on coaches' gender, coaching contexts (i.e., professional-amateur), coaching settings (i.e., team/individual), and their other demographic characteristics (i.e., coaching experience, coaching educational level, and coaching certificate level). Future coach education programs should emphasize the development of coaches' competencies in identifying and accessing eligible sports science knowledge sources and lack of money for acquiring information while also tailoring the messages based on differences in coaching contexts, coaching settings, and coaches' demographic characteristics so as to ensure successful knowledge transfer.

Assessment of 3D T2-weighted high-sampling-efficiency technique (SPACE) for detection of cerebellar tonsillar motion: new useful sign for Chiari I malformation.

OBJECTIVE: To describe tonsillar blackout sign (TBS) on three-dimensional (3D)-SPACE, evaluate its performance in identifying Chiari malformation (CM1) as diagnostic marker, and investigate its role in differentiation of symptomatic and asymptomatic CM1. METHODS: One-hundred fifty-six patients were divided into two groups based on caudal displacement of cerebellar tonsils: CM1 (Group I) and non-CM1 (Group II). Group I was subclassified as symptomatic and asymptomatic by a neurosurgeon. Two radiologists evaluated TBS and cerebrospinal fluid flow abnormality. RESULTS: All subjects presenting TBS had CM1. Difference in presence of TBS between Group I and Group II was highly significant (P<.001).Grading of TBS in symptomatic patients was significantly higher than that in asymptomatic patients (P<.001). CONCLUSION: TBS is highly suggestive of CM1 and potentially useful in differentiation of symptomatic and asymptomatic CM1.

Evaluation of aqueductal patency in patients with hydrocephalus: three-dimensional high-sampling-efficiency technique (SPACE) versus two-dimensional turbo spin echo at 3 Tesla.

OBJECTIVE: To compare the accuracy of diagnosing aqueductal patency and image quality between high spatial resolution three-dimensional (3D) high-sampling-efficiency technique (sampling perfection with application optimized contrast using different flip angle evolutions [SPACE]) and T2-weighted (T2W) two-dimensional (2D) turbo spin echo (TSE) at 3-T in patients with hydrocephalus. MATERIALS AND METHODS: This retrospective study included 99 patients diagnosed with hydrocephalus. T2W 3D-SPACE was added to the routine sequences which consisted of T2W 2D-TSE, 3D-constructive interference steady state (CISS), and cine phase-contrast MRI (PC-MRI). Two radiologists evaluated independently the patency of cerebral aqueduct and image quality on the T2W 2D-TSE and T2W 3D-SPACE. PC-MRI and 3D-CISS were used as the reference for aqueductal patency and image quality, respectively. Inter-observer agreement was calculated using kappa statistics. RESULTS: The evaluation of the aqueductal patency by T2W 3D-SPACE and T2W 2D-TSE were in agreement with PC-MRI in 100% (99/99; sensitivity, 100% [83/83]; specificity, 100% [16/16]) and 83.8% (83/99; sensitivity, 100% [67/83]; specificity, 100% [16/16]), respectively (p < 0.001). No significant difference in image quality between T2W 2D-TSE and T2W 3D-SPACE (p = 0.056) occurred. The kappa values for inter-observer agreement were 0.714 for T2W 2D-TSE and 0.899 for T2W 3D-SPACE. CONCLUSION: Three-dimensional-SPACE is superior to 2D-TSE for the evaluation of aqueductal patency in hydrocephalus. T2W 3D-SPACE may hold promise as a highly accurate alternative treatment to PC-MRI for the physiological and morphological evaluation of aqueductal patency.

Misplaced central venous catheter in the vertebral artery: endovascular treatment of foreseen hemorrhage during catheter withdrawal.

PURPOSE: We report on the endovascular management of hemorrhage with stent-graft due to a misplaced central venous catheter in the vertebral artery (VA) during percutaneous internal jugular vein catheterization in a child. METHODS: A 16-year-old female was presented with the diagnosis of familial Mediterranean fever related chronic renal insufficiency. An attempt was made to place a central venous catheter via the right internal jugular vein without image guidance and the patient experienced dyspnea and pain at the catheter insertion site. Computerized tomography (CT) showed hemorrhage in the cervical region and upper mediastinum, also reformatted images showed that the catheter was passing through the proximal part of the VA and terminating in the right mediastinum. The catheter was removed during manual compression under angio-flouroscopic monitoring and ongoing extravasation was observed. A stent-graft was placed to the bleeding site of the VA. RESULTS: Angiography immediately after the stent-graft placement revealed complete disappearance of extravasation and patency of vertebral and subclavian arteries. CONCLUSION: Central venous catheterization (CVC) is not a risk-free procedure and arterial injuries are in a wide spectrum from a simple puncture to rupture of the artery. Inadvertent VA cannulation is a rare and serious complication necessitating prompt diagnosis and early treatment. If an arterial injury with a large-caliber catheter occurs, endovascular treatment with stent-graft seems to be a safe and effective option in terms of achieving hemostasis and preserving arterial patency. Recent findings suggest that endovascular management of inadvertent cervical arterial injury secondary to CVC seems to be the safest strategy.