Is pneumatization of middle turbinates compensatory or congenital?

Objective

To determine the frequency of concha bullosa (CB) and the association between the degree of pneumatization and the severity of septum deviation in both paediatric and adult groups by CT evaluation and to investigate whether the pneumatization of middle turbinates is compensatory or congenital.

Method

We retrospectively reviewed digitally stored paranasal sinus CT images of 86 paediatric and 204 adult patients. The severity of the deviation and cross-sectional area of the pneumatized area of the CB were determined using tomography images. The septums were divided into three groups according to the severity of deviation. The cross-sectional area of the contralateral side divided by the cross-sectional area of the deviation was calculated and described as the interturbinate ratio.

Results

When bilateral CB was found, the pneumatization of the CB was more prominent on the contralateral side than on the deviation side in both the paediatric and the adult groups. However, we found that the interturbinate ratios were not statistically different between the paediatric and adult groups. Also, the interturbinate ratios were independent degrees of deviation in children and adults. The frequency of CB was low in the adult group compared with the paediatric group.

Conclusion

Interturbinate ratios were not statistically different between paediatric and adult groups and were independent of the severity of deviation. These findings suggest that the pneumatization process is not compensatory.     

Augmentation or reconstruction of PCL? A quantitative review

Purpose

The purpose of this quantitative review is to document effectiveness and complications of posterior cruciate ligament (PCL) surgery and compare outcomes, advantages and disadvantages of reconstructive and augmentation procedures.

Methods

A systematic literature search was performed in PubMed, Medline, Ovid, Google Scholar and Embase databases using the combined keywords “PCL reconstruction,” “PCL augmentation,” “clinical outcomes” and “functional outcomes” with no limit for year of publication. Articles were included if they reported data on clinical, functional and imaging outcomes who had undergone reconstruction or augmentation of the PCL for management of PCL injuries. Two authors screened the selected articles for title, abstract and full text in accordance with predefined inclusion and exclusion criteria. The methodological quality of all articles was assessed by two authors according to the Coleman methodology score. The critical appraisal was made using the Physiotherapy Evidence Database (PEDro) scale.

Results

A total of 34 studies, 22 retrospective, 9 prospective and 5 were randomized control trials were included by full text. The modified Coleman methodology score averaged 70.8 (SD 6.5), median 73 (range from 60 to 82). At IKDC assessment, the average rate of normal (A) and nearly normal (B) outcomes was 89.8 % (SD 4.2) (from 85 to 93 %; median 91.4) after PCL augmentation and 80.1 % (SD 12.4) after PCL reconstruction (from 57.2 to 100 %; median 81.8 %) were rated as normal (A) and nearly normal (B). The average Lysholm Knee Scores after PCL augmentation were 93.1 points (SD 1.9) and ranged from 82.1 to 94.2 (median 90.5) after PCL reconstruction. The KT 1000 difference improved from an average preoperative difference of 8.8 mm (SD 0.9) to an average postoperative of 2.1 mm (SD 0.6) after PCL augmentation (average improvement of 6.7 mm (SD 4.7)) and from 8.2 (SD 3.6) to 2.3 mm (SD 2.0) (average improvement of 5.9 mm SD 4.2) after PCL reconstruction. Postoperatively, the Telos stress radiographic side to side difference averagely improved by 8.6 mm (SD 6.1) after PCL augmentation, from 11.1 mm (SD 1.4) to 2.5 mm (SD 0.4), and by 8.0 mm (SD 5.7) after PCL reconstruction, from 11.5 mm (SD 2.2) to 3.5 mm (SD 1.3).

Conclusions

Augmentation and reconstruction procedures are grossly equivalent, but more data examining the long-term functional status, recovery to preinjury daily and sport activities and occurrence of degenerative changes are needed.

Level of evidence

IV.     

Musculoskeletal applications of platelet-rich plasma: fad or future?

OBJECTIVE: The purpose of this article is to detail the biology of platelet-rich plasma (PRP), critically review the existing literature, and discuss future research applications needed to adopt PRP as a mainstay treatment method for common musculoskeletal injuries. CONCLUSION: Any promising minimally invasive therapy such as PRP deserves further investigation to avoid surgery. Diagnostic imaging outcome assessments, including ultrasound-guided needle precision, should be included in future investigations.     

High or low dose radioiodine ablation of thyroid remnants?

The need for high dose radioiodine for ablation of remnants in patients with thyroid cancer is still in question. We compared the effectiveness of high and low dose 131I for ablation in patients in a prospective randomized study after surgical thyroidectomy. Twenty patients with differentiated pT2-3NoMo thyroid cancer were studied. The uptake was 5%-10% at 24 h. Ten patients received 100 mCi, the others 30 mCi 131I. Three months later all patients received a therapeutic dose of 150 mCi 131I. Another twenty patients with known distant metastases (pulmonary and/or bone) of differentiated thyroid cancer were studied. The remnant uptake was between 4%-10%. Ten patients received 300 mCi and ten 30 mCi 131I as ablation dose. Three months later all received 300 mCi 131I. The uptake at day seven was calculated for the same metastases from a whole body scan after both treatments. If effective ablation was defined as 24 h uptake in the remnant of less than 1%, then the ablation was effective in eight out of ten of the high dose and in seven out of ten of the low dose group. In pT2-3, N X M1 patients the ablation was effective in seven out of ten cases in both groups. If "effective" ablation was defined as an uptake of less than 0.5%, then the ablation was effective both in NoMo and in N X M1 patients in five out of ten with low dose and in six out of ten with high dose ablation treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Adverse effects of creatine supplementation: fact or fiction?

The consumption of oral creatine monohydrate has become increasingly common among professional and amateur athletes. Despite numerous publications on the ergogenic effects of this naturally occurring substance, there is little information on the possible adverse effects of this supplement. The objectives of this review are to identify the scientific facts and contrast them with reports in the news media, which have repeatedly emphasised the health risks of creatine supplementation and do not hesitate to draw broad conclusions from individual case reports. Exogenous creatine supplements are often consumed by athletes in amounts of up to 20 g/day for a few days, followed by 1 to 10 g/day for weeks, months and even years. Usually, consumers do not report any adverse effects, but body mass increases. There are few reports that creatine supplementation has protective effects in heart, muscle and neurological diseases. Gastrointestinal disturbances and muscle cramps have been reported occasionally in healthy individuals, but the effects are anecdotal. Liver and kidney dysfunction have also been suggested on the basis of small changes in markers of organ function and of occasional case reports, but well controlled studies on the adverse effects of exogenous creatine supplementation are almost nonexistent. We have investigated liver changes during medium term (4 weeks) creatine supplementation in young athletes. None showed any evidence of dysfunction on the basis of serum enzymes and urea production. Short term (5 days), medium term (9 weeks) and long term (up to 5 years) oral creatine supplementation has been studied in small cohorts of athletes whose kidney function was monitored by clearance methods and urine protein excretion rate. We did not find any adverse effects on renal function. The present review is not intended to reach conclusions on the effect of creatine supplementation on sport performance, but we believe that there is no evidence for deleterious effects in healthy individuals. Nevertheless, idiosyncratic effects may occur when large amounts of an exogenous substance containing an amino group are consumed, with the consequent increased load on the liver and kidneys. Regular monitoring is compulsory to avoid any abnormal reactions during oral creatine supplementation.     

Early detection of colorectal tumors: CT or MRI?

Cancer screening is currently offered for the organs breast, prostate, cervix and colorectum. With progressing technique in computerized tomography (CT) and magnetic resonance imaging (MRI) the colorectum can be increasingly better assessed. Because in CT and MRI also other organs are imaged with the colorectum, a colorectal screening automatically becomes a multiorgan screening. CT and MRI protocols designed for early detection of colorectal tumors are presented and discussed with regard to monoorganscreening (in CT: low dose, no i.v. contrast) and multiorganscreening (in CT: diagnostic dose for neighboured organs with i.v. contrast). More information under http://www.multiorganscreening.org.     

High or low dose radioiodine ablation of thyroid remnants?

The need for high dose radioiodine for ablation of remnants in patients with thyroid cancer is still in question. We compared the effectiveness of high and low dose¹³¹I for ablation in patients in a prospective randomized study after surgical thyroidectomy. Twenty patients with differentiatedpT2-3NoMo thyroid cancer were studied. The uptake was 5%–10% at 24 h. Ten patients received 100 mCi, the others 30 mCi¹³¹I. Three months later all patients received a therapeutic dose of 150 mCi¹³¹I. Another twenty patients with known distant metastases (pulmonary and/or bone) of differentiated thyroid cancer were studied. The remnant uptake was between 4%–10%. Ten patients received 300 mCi and ten 30 mCi¹³¹I as ablation dose. Three months later all received 300 mCi¹³¹I. The uptake at day seven was calculated for the same metastases from a whole body scan after both treatments. If effective ablation was defined as 24h uptake in the remnant of less than 1%, then the ablation was effective in eight out of ten of the high dose and in seven out of ten of the low dose group. In pT2-3, NxM1 patients the ablation was effective in seven out of ten cases in both groups. If effective ablation was defined as an uptake of less than 0.5%, then the ablation was effective both in NoMo and in NxM1 patients in five out of ten with low dose and in six out of ten with high dose ablation treatment. Seventh day uptake in 20 metastases after the second dose was at mean 3.6 times (range 2.8–4.3) higher than after the first, while there was no significant difference in TSH levels. In two patients,¹³¹I kinetics over a bone metastasis were recorded continuously during 300 mCi ablation treatment and 300 mCi therapeutic treatment without any significant difference. We therefore recommend a 30 mCi ablation dose for all patients with differentiated thyroid cancer after surgical thyroidectomy, followed by a 300 mCi treatment dose in pT2-3N1M x or pT2-3N x M1 patients, while in pT2-3NoMo low dose ablation will be a sufficient treatment.Supported in part by Deutsche Forschungsgemeinschaft (grant Cr 52/4-1)     

The role of gene therapy. Fact or fiction?

Current research in molecular biology and genetics has dramatically advanced the understanding of the cellular events involved in homeostasis, disease, injury, and healing processes of the tissues of the musculoskeletal system. Recently, genetic predispositions to diseases have been described which offer novel means to address musculoskeletal disorders. Growth factors and cytokines have been identified as key elements in both the injured and healing states. Gene therapy offers an elegant solution to the delivery of therapeutic proteins to the site of disease or injury.