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ObjectiveTo assess the relationship between low- and high-grade subchondral insufficiency fracture of the knee (SIFK) and meniscal tear/type/location, severity of meniscal extrusion, grade of chondrosis, and extent of surrounding edema-like marrow signal intensity.Materials and methodsOur retrospective study included 219 patients with knee pain and SIFK seen on MRI. SIFK lesions were categorized from grade 1 to 4 with a low grade (1 and 2) vs high grade (3 and 4) distinction. Associations between SIFK grade, location, lesion dimensions, edema-like marrow signal intensity, incidence of meniscal tears/type/location, and chondrosis (grade 0 to grade 4), as well as patients’ age and weight, were assessed.ResultsOur analysis consisted of 115 males and 104 females with 17% of the patients showing grade 1 SIFK, 59% grade 2, 16% grade 3, and 8% grade 4. No chondrosis or low-grade chondrosis was mostly present in patients with low-grade SIFK (68.9%), whereas high-grade chondrosis was mostly present in patients with high-grade SIFK lesions (65.4%) (p < 0.01). Further sub-analysis demonstrated that high-grade SIFK was associated with high-grade chondrosis in the same compartment (p < 0.01) but not in the adjacent compartment. There was a significant difference in the extent of edema-like marrow signal intensity between the two groups, with high-grade SIFK more frequently demonstrating severe edema-like marrow signal intensity compared to low-grade SIFK (p < 0.01).ConclusionHigh-grade SIFK lesions are associated with unicompartmental high-grade chondrosis.

Background/Objectives: Vertebral discitis osteomyelitis (VDO) is a serious infection involving the vertebral bodies and intervertebral discs, often requiring biopsy for pathogen identification. However, biopsy yields are variable, and guidance on patient selection remains limited. This study aimed to assess how biopsy culture results influence clinical management and to develop imaging-based scoring systems to predict biopsy outcomes. Methods: In this retrospective study, 70 patients who underwent image-guided vertebral biopsy for suspected VDO between 2013 and 2022 were reviewed. Pre-biopsy MRI and CT findings were scored using novel, simplified criteria. MRI was graded based on soft tissue involvement, while CT evaluated the presence or absence of a vacuum phenomenon. Culture results were correlated with imaging scores and subsequent changes in antibiotic management. Statistical analysis included logistic regression, ROC analysis, and interobserver agreement using Cohen’s Kappa. Results: Of the 70 patients, 27 (38.6%) had positive cultures, and 20 (28.5%) experienced changes in management. Among the 48 patients with both MRI and CT imaging, MRI scores indicating soft tissue involvement and absence of the vacuum sign on CT were independent predictors of positive culture (p = 0.022 and p = 0.047, respectively). The combined predictive model showed an AUC of 0.76. Interobserver agreement was excellent (κ = 0.90 for MRI, κ = 0.95 for CT). Conclusions: MRI and CT features can be used to predict biopsy yield and guide clinical decisions in suspected VDO. These scoring systems may help clinicians identify patients most likely to benefit from biopsy, potentially improving outcomes and minimizing unnecessary procedures.

Background Patients with renal failure suffer from fluid overload which is a risk factor for mortality and morbidity. Therefore, fluid status assessment in patients on regular hemodialysis is very important. Dry weight assessment by clinical parameters is not always reliable. We evaluate the role of inferior vena cava ultrasound in estimating fluid overload in regular hemodialysis patients. Results A total of 45 persons, 30 end-stage renal disease patients on regular hemodialysis in group A (18 men and 12 women) and 15 healthy persons in group B (10 men and 5 women), were included in the study. The patients in group A ages ranged from 29 to 70 years with a mean of 48.38 ± 12.70 years and in group B ages ranged from 25 to 55 years with a mean of 34.93 ± 8.26. By clinical methods, the mean dry weight was 68.37 kg (68.37 ± 10.42). After HD mean, IVCe decreased from 2.01 ± 0.29 to 1.79 ± 0.22 cm ( P < 0.001) similarly, mean IVCi decreased from 0.99 ± 0.48 to 0.64 ± 0.39 cm ( P < 0.001). Changes in IVCD were significantly correlated with alterations in body weight following dialysis ( P < 0.001). The IVC-CI increased significantly after dialysis ( P < 0.001). IVCD and its IVC-CI reflected alterations in fluid status ( P < 0.001). Considering the clinical parameters of fluid status, following HD mean, heart rate increased from 81.80 ± 5.15 beats per minute to 89.87 ± 6.42, ( P < 0.001), systolic blood pressure decreased from 130 ± 18.43 mmHg to 113.33 ± 15.27 ( P < 0.001), and diastolic blood pressure decreased from 80.17 ± 10.12 mmHg to 71.50 ± 9.29 ( P < 0.001). Conclusion It was found a significant correlation between IVCD and IVC-CI with ultrafiltration of hemodialysis. Thus, IVC ultrasound can be used in dry weight assessment in ESRD patients on regular HD by measurement of IVCD and IVC-CI before and after hemodialysis.

Background Chronic obstructive pulmonary disease (COPD) has many extrapulmonary comorbidities, and metabolic syndrome (MetS) is one of them. Scant data are available on MetS in Egyptian patients with COPD. Objective The purpose of the current research was to determine the frequency and clinical characteristics of MetS among Egyptian patients with stable COPD. Patients and methods A prospective study including 70 (64 males and six females) patients with stable COPD was conducted. Clinical assessment, pulmonary function, and other laboratory studies were performed. Results MetS was present in 31 patients with COPD (44.3%). BMI and high-sensitivity C-reactive protein were significantly higher in patients with COPD with MetS than those without MetS ( P =0.02 and 0.01, respectively). Age of the patients, duration of COPD, grade of dyspnea, and pulmonary function tests had no significant difference between those with MetS versus those without it. There was a significant negative correlation between plasma triglyceride level, as the only one of the variables of MetS, and some of parameters of pulmonary function test. Conclusion MetS is relatively frequent among patients with COPD. Plasma triglyceride level is the only parameter of MetS to have a significant correlation with pulmonary function tests. Apart from BMI and high-sensitivity C-reactive protein, no other parameter among patients with COPD has a significant relationship with MetS.

Category: Ankle Introduction/Purpose: Ankle arthrodesis (AA) is frequently employed in the treatment of end-stage ankle arthritis, which is common following trauma and athletic injuries. While AA remains a popular therapeutic option, little data exists about activity and sporting capacity following AA. The objective of this research was to determine functional outcomes and sporting activity levels in patients following AA. Methods: Validated questionnaires were emailed to 35 patients with a history of AA at an average follow-up of 52 months. Functional outcomes were assessed using the Foot and Ankle Disability Index (FADI), as well as the associated FADI-Sport. Responses were compared to those from a control population of 24 patients scheduled for AA, at an average preoperative visit of 3 months. Activity levels were assessed prior to injury as well as pre- and post-operatively using the Tegner activity level scale. Results: Average Tegner scores of the 35 surgical patients decreased from 3.82 (SE±0.38) before their injury, to 1.15 (SE±0.19) immediately pre-op, with recovery to 2.67 (SE±0.26) following fusion. Average post arthrodesis FADI and FADI-sport scores in our patients were 76.5% (SE±3.19%) and 33.8% (SE±23.06%). For the preoperative control population, corresponding scores were 47.41% (SE=2.61%) and 22.24% (SE=1.03%). Conclusion: Following AA, we found that patients improved upon their pre-op Tegner score, although they did not return to their before injury level of sporting participation. Additionally, patients reported that they had no current dysfunction with their lower leg. Thus, patients undergoing AA should expect improved lower leg function, though will not likely return to their pre-injury level of activity.

American Society of Clinical Oncology (ASCO) guidelines recommend only office visits and mammograms as the primary modalities for patient surveillance after treatment for breast carcinoma. This study aimed to quantify differences in posttreatment surveillance among medical oncologists, radiation oncologists, and surgeons. We e-mailed a survey to the 3,245 ASCO members who identified themselves as having breast cancer as a major focus of their practices. Questions assessed the frequency of use of 12 specific surveillance modalities for 5 posttreatment years. Of 1,012 total responses, 846 were evaluable: 5% from radiation oncologists, 70% from medical oncologists, and 10% from surgeons; 15% were unspecified. Marked variation in surveillance practices were noted within each specialty and among specialties. There are notable variations in surveillance intensity. This suggests overuse or underuse or misuse of scarce medical resources.

There is little published evidence regarding intraoperative and postoperative complications in patients with ventriculoperitoneal shunts who undergo cholecystectomy. Nationwide Department of Veterans Affairs databases were searched to identify patients with International Classification of Diseases, 9th revision, Clinical Modification codes for a VP shunt who later had a cholecystectomy during fiscal years 1994 to 2003. Charts on these patients were obtained and reviewed. Twenty-three patients were deemed evaluable. Of these, 8 had laparoscopic converted to open cholecystectomies. All conversions were owing to dense adhesions. There were 2 cases of postoperative shunt infection that required shunt removal and replacement. The rate of conversion from laparoscopic to open cholecystectomy was 57% in this study, significantly higher than the reported rate of conversion for patients without shunts in Department of Veterans Affairs Medical Centers (5%). Cholecystectomy in adult patients with a preexisting ventriculoperitoneal shunt appears to result in a shunt infection rate similar to that reported after shunt insertion or revision.

PurposeTo determine the prevalence, radiographic features and reporting rate of, and the association between the congenital anterior and posterior C1 arch anomalies.MethodsThe computed tomography (CT) images of the cervical spines of all patients over 18 years who had CT examinations in our hospital during the study period were reviewed to evaluate for congenital anomalies of the anterior and posterior C1 arches. Radiology reports of the corresponding CT examinations were reviewed to determine the reporting rate of these defects.ResultsOf 3273 subjects, 185 (5.65%) had congenital atlas anomalies: 169 isolated posterior (5.16%), 15 combined anterior and posterior (bipartite, 0.46%), and one isolated anterior (0.031%) arch defects. Females had a higher prevalence than males (7.46 versus 4.72%, P = 0.0013). Eighty-three cases (44.9%) of C1 arch anomalies were not reported. The Currarino type A, B, C and E posterior arch defects accounted for 81.6, 8.1, 1.1, and 0.5% of all arch anomalies while type D was not observed. Fifteen patients (0.46%) had combined anterior and posterior arch anomalies (bipartite atlas) versus only one with an isolated anterior C1 defect, indicating a significant association between the anterior and posterior arch defects (P < 0.0001).ConclusionsAlthough some types of congenital C1 arch anomalies are rare, type A defects are relatively common radiological findings that are unreported approximately 45% of the time. Based on the significant association between the anterior and posterior arch defects, we propose possible mechanisms for the formation of the bipartite atlas.